Healthcare Provider Details

I. General information

NPI: 1104540665
Provider Name (Legal Business Name): DHRUVI PRAVINCHANDRA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SOUTH DR STE 10
MOUNTAIN VIEW CA
94040-4210
US

IV. Provider business mailing address

505 SOUTH DR STE 10
MOUNTAIN VIEW CA
94040-4210
US

V. Phone/Fax

Practice location:
  • Phone: 650-964-1300
  • Fax:
Mailing address:
  • Phone: 310-307-9129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number111361
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number39078
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: