Provider Demographics
NPI:1891042198
Name:PATEL, PUNAM ANIL
Entity Type:Individual
Prefix:
First Name:PUNAM
Middle Name:ANIL
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HATIKVA WAY
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2333
Mailing Address - Country:US
Mailing Address - Phone:978-251-3712
Mailing Address - Fax:
Practice Address - Street 1:20 HATIKVA WAY
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2333
Practice Address - Country:US
Practice Address - Phone:978-251-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist