Provider Demographics
NPI:1245542620
Name:PATEL, KUNAL NAROTTAMBHAI (DMD)
Entity type:Individual
Prefix:
First Name:KUNAL
Middle Name:NAROTTAMBHAI
Last Name:PATEL
Suffix:
Gender:M
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 JEFFERSON SQ APT 7D
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1136
Mailing Address - Country:US
Mailing Address - Phone:617-320-2706
Mailing Address - Fax:
Practice Address - Street 1:155 THOMASTON AVE # C12
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1020
Practice Address - Country:US
Practice Address - Phone:203-575-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010292122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist