Vipul Anant Patel, DMD
Individual provider Active NPI General Practice Dentistry · Portland, CT
NPI 1336339779 · NPPES record last updated Sep 26, 2012
Key facts
- NPI
- 1336339779
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 009785 (CT)
- Practice address
- 553 Portland Cobalt Rd
Portland, CT 06480-1968 - Phone
- (860) 751-9195
- NPI assigned
- Aug 1, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160803002119 | CT | Order and Referring Only - Oral Surgery |
2365736006 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9785 | CT | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sono Dental Group, LLC | General Practice | Past | Accepting new patients |
| SPH2 Enterprise, LLC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 009785 | CT | Yes |
Addresses
Primary practice location
553 Portland Cobalt Rd
Portland, CT 06480-1968
Mailing address
553 Portland Cobalt Rd
Portland, CT 06480-1968
Phone (860) 751-9195
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02813156 | Medicaid | NY | |
| 009-785 | Other | CT | CT DENTAL LICENCE NUMBER |
| 908002145 | Medicaid | CT |
Other providers in Portland, CT
- Sara Oconnell
- Carly M Odesina
- Jennifer Owens
- Rupesh Pandey
- Stephen P Paschall
- Michelle M Pellin
- Juliette Piazza
- Karen Pickel
- Lauren A. Pisano
- Portland Board of Education
All providers in Portland, CT · General Practice Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.