Healthcare Provider Details

I. General information

NPI: 1497843403
Provider Name (Legal Business Name): BRIJESH J PATEL M.D., D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PARK LN STE # 110
MOORPARK CA
93021-2113
US

IV. Provider business mailing address

145 PARK LANE STE # 110
MOORPARK CA
93021
US

V. Phone/Fax

Practice location:
  • Phone: 805-532-1331
  • Fax: 805-532-1371
Mailing address:
  • Phone: 805-532-1331
  • Fax: 805-532-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOMS 60
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: