Provider Demographics
NPI:1245715408
Name:PATEL, MAULIKKUMAR N (DMD)
Entity type:Individual
Prefix:
First Name:MAULIKKUMAR
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 AMERICAN LEGION HWY
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4701
Mailing Address - Country:US
Mailing Address - Phone:857-888-8000
Mailing Address - Fax:617-323-3003
Practice Address - Street 1:950 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4701
Practice Address - Country:US
Practice Address - Phone:857-888-8000
Practice Address - Fax:617-323-3003
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist