Healthcare Provider Details

I. General information

NPI: 1528460656
Provider Name (Legal Business Name): ROSHNI PATEL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 JACKLIN RD
MILPITAS CA
95035-3225
US

IV. Provider business mailing address

371 JACKLIN RD
MILPITAS CA
95035-3225
US

V. Phone/Fax

Practice location:
  • Phone: 408-263-2252
  • Fax:
Mailing address:
  • Phone: 408-263-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64597
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9949
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: