Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN21821 | FL |
N | 1223G0001X | General Practice | DN21821 | FL |
N | 213EG0000X | General Practice | DN21821 | FL |
N | 1223G0001X | General Practice | DS040810 | PA |
N | 213EG0000X | General Practice | DS040810 | PA |
N | 1223P0221X | Pediatric Dentist | DN21821 | FL |
Y | 1223P0221X | Pediatric Dentist | DS040810 | PA |
NPI | 1033573662 |
---|---|
Provider Name | Dr. Priya Vijapura Patel |
First Address | Bethlehem, PA 18015-2096 |
Second Address | Bethlehem, PA 18015-2096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2016 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023426900 | (05) | FL |