Healthcare Provider Details

I. General information

NPI: 1275719783
Provider Name (Legal Business Name): AJAY R. PATEL, D. D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 G ST BLDG M
MERCED CA
95340-0964
US

IV. Provider business mailing address

3381 G ST BLDG M
MERCED CA
95340-0964
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-2764
  • Fax: 209-722-4861
Mailing address:
  • Phone: 209-722-2764
  • Fax: 209-722-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number55551
License Number StateCA

VIII. Authorized Official

Name: MRS. HELEN FRANKLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-722-2764