Healthcare Provider Details

I. General information

NPI: 1972278281
Provider Name (Legal Business Name): SHIVALI CHOPRA PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 TRAVIS BLVD
FAIRFIELD CA
94533-3429
US

IV. Provider business mailing address

4255 WAGNER CT
FAIRFIELD CA
94534-9630
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-6060
  • Fax: 505-255-0925
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: