Provider Demographics
NPI:1790190742
Name:PATEL, HIRALBEN
Entity Type:Individual
Prefix:
First Name:HIRALBEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 KNIGHTS RD
Mailing Address - Street 2:APT F 24
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3577
Mailing Address - Country:US
Mailing Address - Phone:213-984-5712
Mailing Address - Fax:
Practice Address - Street 1:1212 VETERANS HWY
Practice Address - Street 2:SUITE A1
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2512
Practice Address - Country:US
Practice Address - Phone:213-984-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist