Healthcare Provider Details

I. General information

NPI: 1467362350
Provider Name (Legal Business Name): SOUTH NAPA MODERN DENTISTRY, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 W IMOLA AVE
NAPA CA
94559-4722
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 707-302-6645
  • Fax: 707-927-4904
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DILANKUMAR PATEL
Title or Position: OWNER
Credential: DDS
Phone: 707-302-6645