Provider Demographics
NPI:1932332863
Name:PATEL, KOMAL (DMD)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
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 1:11 VIOLA TER
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4754
Mailing Address - Country:US
Mailing Address - Phone:646-321-9140
Mailing Address - Fax:
Practice Address - Street 1:11 VIOLA TER
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4754
Practice Address - Country:US
Practice Address - Phone:646-321-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02414000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist