Provider Demographics
NPI:1730149717
Name:PATEL, JAGADISHVER M (DDS)
Entity type:Individual
Prefix:
First Name:JAGADISHVER
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 W WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1646
Mailing Address - Country:US
Mailing Address - Phone:610-328-4645
Mailing Address - Fax:610-328-4645
Practice Address - Street 1:599 W WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1646
Practice Address - Country:US
Practice Address - Phone:610-328-4645
Practice Address - Fax:610-328-4645
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020407L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0537400Medicaid