Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D5828 | AZ |
N | 1223D0001X | Dental Public Health | D5828 | AZ |
NPI | 1720055270 |
---|---|
Provider Name | Dr. Swati Patel |
First Address | Nogales, AZ 85621-1063 |
Second Address | Nogales, AZ 85621-1063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 14/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
812760 | (05) | AZ |