Healthcare Provider Details

I. General information

NPI: 1376902155
Provider Name (Legal Business Name): PRIYA PATEL SHETH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 MAGNOLIA AVE
CORONA CA
92879-3202
US

IV. Provider business mailing address

1195 MAGNOLIA AVE
CORONA CA
92879-3202
US

V. Phone/Fax

Practice location:
  • Phone: 951-339-3005
  • Fax:
Mailing address:
  • Phone: 510-378-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number101913
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: