Provider Demographics
NPI:1952433708
Name:PATEL, MITESH R (DDS)
Entity type:Individual
Prefix:DR
First Name:MITESH
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:50 MOUNT PROSPECT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1900
Mailing Address - Country:US
Mailing Address - Phone:973-249-0450
Mailing Address - Fax:973-405-6512
Practice Address - Street 1:50 MOUNT PROSPECT AVE FL 2
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1900
Practice Address - Country:US
Practice Address - Phone:973-249-0450
Practice Address - Fax:973-405-6512
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20132332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8343004Medicaid
NJ829126OtherATENA DMO PROVIDRE