Provider Demographics
NPI:1245695493
Name:PATEL, KAUSHAL
Entity type:Individual
Prefix:
First Name:KAUSHAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 NORTHAMPTON ST
Mailing Address - Street 2:APT 1A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1870
Mailing Address - Country:US
Mailing Address - Phone:201-238-3178
Mailing Address - Fax:
Practice Address - Street 1:319 LYNNWAY
Practice Address - Street 2:#1
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1811
Practice Address - Country:US
Practice Address - Phone:781-599-5437
Practice Address - Fax:781-599-5436
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18571011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice