Healthcare Provider Details

I. General information

NPI: 1518357755
Provider Name (Legal Business Name): VIMAL PATEL DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E STETSON AVE
HEMET CA
92543-7177
US

IV. Provider business mailing address

240 E STETSON AVE
HEMET CA
92543-7177
US

V. Phone/Fax

Practice location:
  • Phone: 909-645-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD50668
License Number StateCA

VIII. Authorized Official

Name: VIMAL PATEL
Title or Position: DENTIST/OWNER
Credential:
Phone: 909-645-0886