Healthcare Provider Details

I. General information

NPI: 1578744769
Provider Name (Legal Business Name): ALPESH PATEL DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17644 VALLEY BLVD UNIT # 1
BLOOMINGTON CA
92316-1947
US

IV. Provider business mailing address

17644 VALLEY BLVD UNIT 1
BLOOMINGTON CA
92316-1947
US

V. Phone/Fax

Practice location:
  • Phone: 909-877-0650
  • Fax: 909-877-0951
Mailing address:
  • Phone: 909-877-0650
  • Fax: 909-877-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALPESH K PATEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-877-0650