Healthcare Provider Details

I. General information

NPI: 1730287418
Provider Name (Legal Business Name): JAYANTILAL G PATEL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 E. ROSECRANS AVE SUITE # 101
PARAMOUNT CA
90723
US

IV. Provider business mailing address

8131 E. ROSECRANS AVE SUITE # 101
PARAMOUNT CA
90723
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-2984
  • Fax: 562-634-2986
Mailing address:
  • Phone: 562-634-2984
  • Fax: 562-634-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number28605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: