Provider Demographics
NPI:1811030455
Name:PATEL, AMITA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 NEW DOVER RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1912
Mailing Address - Country:US
Mailing Address - Phone:732-381-5828
Mailing Address - Fax:732-382-0340
Practice Address - Street 1:659 NEW DOVER RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1912
Practice Address - Country:US
Practice Address - Phone:732-381-5828
Practice Address - Fax:732-382-0340
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016268001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice