Provider Demographics
NPI:1851439186
Name:PATEL, PURVA R (DDS)
Entity Type:Individual
Prefix:
First Name:PURVA
Middle Name:R
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 1:2240 HIGHWAY 33
Mailing Address - Street 2:SUITE 113
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6104
Mailing Address - Country:US
Mailing Address - Phone:732-774-1744
Mailing Address - Fax:732-377-8668
Practice Address - Street 1:2240 HIGHWAY 33
Practice Address - Street 2:SUITE 113
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-774-1744
Practice Address - Fax:732-377-8668
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI21214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist