Provider Demographics
NPI:1295999043
Name:MAO-PATEL, LOAN SAM (DDS)
Entity type:Individual
Prefix:DR
First Name:LOAN
Middle Name:SAM
Last Name:MAO-PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LOAN
Other - Middle Name:SAM
Other - Last Name:MAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:470 PATCHOGUE HOLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1625
Mailing Address - Country:US
Mailing Address - Phone:631-589-8485
Mailing Address - Fax:
Practice Address - Street 1:470 PATCHOGUE HOLBROOK RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1625
Practice Address - Country:US
Practice Address - Phone:631-589-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500542871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry