Provider Demographics
NPI:1184325813
Name:PATEL, MONICA (DMD)
Entity type:Individual
Prefix:DR
First Name:MONICA
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 1:100 W SQUANTUM ST APT 217
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2137
Mailing Address - Country:US
Mailing Address - Phone:617-764-6894
Mailing Address - Fax:
Practice Address - Street 1:100 W SQUANTUM ST APT 217
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2137
Practice Address - Country:US
Practice Address - Phone:617-764-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1860013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist