Individual
JIMISHKUMAR GHANSHYAMBHAI PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 E NEWTON ST, AEGD DEPARTMENT, BOSTON, MA 02118-2308
(617) 638-4636
Mailing address
35 NORTHAMPTON ST APT 1801, BOSTON, MA 02118-4019
(857) 234-6289
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DL11604
MA
Other
Enumeration date
07/06/2012
Last updated
07/06/2012
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