1811974702 NPI number — UGTI PATEL DMD

Table of content: UGTI PATEL DMD (NPI 1811974702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811974702 NPI number — UGTI PATEL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
UGTI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811974702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SHENANGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16146-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-981-1721
Provider Business Mailing Address Fax Number:
724-981-7025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 SHARON NEW CASTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARRELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16121-1576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-981-1721
Provider Business Practice Location Address Fax Number:
724-981-7025
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS027951L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0012711420010 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012711420012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2617636 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012711420006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012711420008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2395411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012711420013 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012711420007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012711420009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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