Provider Demographics
NPI:1861697930
Name:PHATAK, NEAL (DDS)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:
Last Name:PHATAK
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 1:1 JASONS WAY
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-2037
Mailing Address - Country:US
Mailing Address - Phone:717-867-5088
Mailing Address - Fax:
Practice Address - Street 1:1 JASONS WAY
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-2037
Practice Address - Country:US
Practice Address - Phone:717-867-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050977122300000X
PADS039784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist