Healthcare Provider Details

I. General information

NPI: 1740422641
Provider Name (Legal Business Name): SHITAL PATEL D.D.S. & RAKESH PATEL D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ONTARIO AVE SUITE #103
CORONA CA
92879-3510
US

IV. Provider business mailing address

160 E ONTARIO AVE SUITE #103
CORONA CA
92879-3510
US

V. Phone/Fax

Practice location:
  • Phone: 951-898-8845
  • Fax: 951-898-6985
Mailing address:
  • Phone: 951-898-8845
  • Fax: 951-898-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number44238
License Number StateCA

VIII. Authorized Official

Name: DR. RAKESH R PATEL
Title or Position: SECRETARY
Credential: D.D.S.
Phone: 951-898-8845