Provider Demographics
NPI:1972660868
Name:PATEL, KAVITA PANKAJ (DDS)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:PANKAJ
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 1:1503 SAINT GEORGES AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3425
Mailing Address - Country:US
Mailing Address - Phone:732-382-4104
Mailing Address - Fax:732-388-6078
Practice Address - Street 1:1503 SAINT GEORGES AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3425
Practice Address - Country:US
Practice Address - Phone:732-382-4104
Practice Address - Fax:732-388-6078
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02033900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist