Basic Information
| Provider Information | |||||||||
| NPI: | 1801250444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | AARTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 BRECKENWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275139420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194126862 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 E LEHIGH AVE # PM2 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191251012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157073613 | ||||||||
| FaxNumber: | 2157075405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2016 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DS041349 | PA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1033774390001 | 05 | PA | MEDICAID |