Healthcare Provider Details

I. General information

NPI: 1811507213
Provider Name (Legal Business Name): MALVIKA PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39340 FREMONT BLVD
FREMONT CA
94538-1320
US

IV. Provider business mailing address

855 PINE ST APT 9
SAN FRANCISCO CA
94108-3019
US

V. Phone/Fax

Practice location:
  • Phone: 510-876-0074
  • Fax:
Mailing address:
  • Phone: 919-802-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number105074
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: