Provider Demographics
NPI:1457885923
Name:PATEL, MONIKA
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3021
Mailing Address - Country:US
Mailing Address - Phone:508-473-7900
Mailing Address - Fax:
Practice Address - Street 1:1020 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5024
Practice Address - Country:US
Practice Address - Phone:610-871-6240
Practice Address - Fax:484-892-6240
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0444351223S0112X
MADN18589441223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program