Provider Demographics
NPI:1184151714
Name:PATEL, CHANDNI J (DMD)
Entity type:Individual
Prefix:DR
First Name:CHANDNI
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 24TH ST APT 727
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3985
Mailing Address - Country:US
Mailing Address - Phone:813-943-9209
Mailing Address - Fax:
Practice Address - Street 1:200 WILLOWBROOK LN STE 220
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5697
Practice Address - Country:US
Practice Address - Phone:484-787-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0425621223G0001X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty