Healthcare Provider Details

I. General information

NPI: 1104819713
Provider Name (Legal Business Name): BHOLABHAI N PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16466 NORWALK BLVD
CERRITOS CA
90703-1929
US

IV. Provider business mailing address

16466 NORWALK BLVD
CERRITOS CA
90703-1929
US

V. Phone/Fax

Practice location:
  • Phone: 562-926-6643
  • Fax:
Mailing address:
  • Phone: 562-926-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: