Provider Demographics
NPI:1912344623
Name:PATOLIYA, PRIYA KEYUR
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:KEYUR
Last Name:PATOLIYA
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 1:4205 HORSESHOE WAY
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1063
Mailing Address - Country:US
Mailing Address - Phone:908-391-1714
Mailing Address - Fax:
Practice Address - Street 1:4205 HORSESHOE WAY
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-1063
Practice Address - Country:US
Practice Address - Phone:908-391-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist