Provider Demographics
NPI:1912522327
Name:PATEL, DHARA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:DHARA
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 GRANDVIEW PKWY APT 222
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2092
Mailing Address - Country:US
Mailing Address - Phone:717-602-7165
Mailing Address - Fax:
Practice Address - Street 1:3401 HARTZDALE DR STE 122
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7238
Practice Address - Country:US
Practice Address - Phone:717-763-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice