Healthcare Provider Details

I. General information

NPI: 1104747799
Provider Name (Legal Business Name): PATANADEJ DUSTIN HIGARAVATHN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15296 SADDLEBACK RD
CANYON COUNTRY CA
91387-4722
US

IV. Provider business mailing address

15296 SADDLEBACK RD
CANYON COUNTRY CA
91387-4722
US

V. Phone/Fax

Practice location:
  • Phone: 661-233-6610
  • Fax:
Mailing address:
  • Phone: 661-233-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: