MEDICARE: PERRY PATEL DDS,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	45400	CA

General Provider Information

NPI Number	:	1609259621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERRY PATEL DDS,INC

Provider Business Mailing Address
First Line	:	901 OAK PARK BLVD STE 103
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3409
Country	:	US
Telephone Number	:	805-489-4761
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 OAK PARK BLVD STE 103
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-3409
Country	:	US
Telephone Number	:	805-489-4761
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PERRY PATEL
Credential	:	DDS
Telephone Number	:	805-489-4761

Provider Enumeration Date	:	07/08/2015
Last Update Date	:	07/08/2015

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