Provider Demographics
NPI:1548712151
Name:PATEL DENTAL GROUP OF UPPER VALLEY
Entity type:Organization
Organization Name:PATEL DENTAL GROUP OF UPPER VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-678-4700
Mailing Address - Street 1:11 ELDRIDGE ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1022
Mailing Address - Country:US
Mailing Address - Phone:603-678-4700
Mailing Address - Fax:
Practice Address - Street 1:11 ELDRIDGE ST
Practice Address - Street 2:SUITE #300
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1022
Practice Address - Country:US
Practice Address - Phone:603-678-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037811223G0001X
NH037821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty