Healthcare Provider Details

I. General information

NPI: 1992690903
Provider Name (Legal Business Name): KARISHNEE RAKESH PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST COAST RD
REDWAY CA
95560
US

IV. Provider business mailing address

PO BOX 769
REDWAY CA
95560-0769
US

V. Phone/Fax

Practice location:
  • Phone: 707-923-2783
  • Fax:
Mailing address:
  • Phone: 707-923-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10000858
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: