Provider Demographics
NPI:1295245538
Name:PATEL, SWAGAT K (DMD)
Entity type:Individual
Prefix:
First Name:SWAGAT
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FAY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-2303
Mailing Address - Country:US
Mailing Address - Phone:978-413-2123
Mailing Address - Fax:
Practice Address - Street 1:158 WOOD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2107
Practice Address - Country:US
Practice Address - Phone:978-677-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-30
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist