Active NPI
Mira Krishnakant Patel
- Pediatric Dentistry
- Philadelphia, PA
National Provider Identifier
1093508731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS045240
- Practice address
- 2301 E Allegheny Ave
Philadelphia, PA 19134-4427 - Phone
- (570) 690-6507
- NPI assigned
- May 27, 2025
- Last updated
- Jun 27, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS045240 | PA | Primary |
Addresses
Primary practice location
2301 E Allegheny Ave
Philadelphia, PA 19134-4427
Mailing address
238 S 13TH St Apt 2F
Philadelphia, PA 19107-5626
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250710000002 | PA | Order and Referring Only - Pediatric Dentistry | 8325552417 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS045240 | PA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750982400000",
"number": "1093508731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "238 S 13TH ST APT 2F",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191075626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 E ALLEGHENY AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191344427",
"telephone_number": "570-690-6507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "MIRA",
"middle_name": "KRISHNAKANT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-27",
"last_updated": "2025-06-27",
"certification_date": "2025-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS045240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.