Provider Demographics
NPI:1821542176
Name:PATEL, AMY R (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KROLL TER
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3839
Mailing Address - Country:US
Mailing Address - Phone:201-424-9234
Mailing Address - Fax:
Practice Address - Street 1:191 RTE 206 STE 11
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9002
Practice Address - Country:US
Practice Address - Phone:973-927-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026791001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry