Provider Demographics
NPI:1801250444
Name:PATEL, AARTI
Entity type:Individual
Prefix:
First Name:AARTI
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 1:303 BRECKENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9420
Mailing Address - Country:US
Mailing Address - Phone:919-412-6862
Mailing Address - Fax:
Practice Address - Street 1:100 E LEHIGH AVE # PM2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1012
Practice Address - Country:US
Practice Address - Phone:215-707-3613
Practice Address - Fax:215-707-5405
Is Sole Proprietor?:No
Enumeration Date:2016-04-10
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0413491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033774390001Medicaid