Individual
MAMTA VIPIN PATEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
124 BROAD ST, STAMFORD, CT 06901-2702
(860) 861-3531
(203) 348-0643
Mailing address
124 BROAD ST, STAMFORD, CT 06901-2702
(860) 861-3531
(203) 348-0643
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009630
CT
1223G0001X
General Practice Dentistry
54329
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236354
—
CT
Enumeration date
07/26/2006
Last updated
05/20/2011
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