Provider Demographics
NPI:1841663309
Name:PATEL, VISHAL PRAFUL (DDS)
Entity type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:PRAFUL
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9168
Mailing Address - Country:US
Mailing Address - Phone:973-830-7970
Mailing Address - Fax:
Practice Address - Street 1:600 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3535
Practice Address - Country:US
Practice Address - Phone:973-633-5440
Practice Address - Fax:973-633-1903
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI026352001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program