Provider Demographics
NPI:1457976987
Name:PATEL, SHIVAM D (DMD)
Entity Type:Individual
Prefix:
First Name:SHIVAM
Middle Name:D
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 1:49 JACKSON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5068
Mailing Address - Country:US
Mailing Address - Phone:978-614-5883
Mailing Address - Fax:
Practice Address - Street 1:49 JACKSON ST UNIT B
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5068
Practice Address - Country:US
Practice Address - Phone:978-258-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858645122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist