Healthcare Provider Details

I. General information

NPI: 1093650061
Provider Name (Legal Business Name): PATEL PROFESSIONAL DENTAL CORPOORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W BASE LINE RD
RIALTO CA
92376-3306
US

IV. Provider business mailing address

228 W BASE LINE RD
RIALTO CA
92376-3306
US

V. Phone/Fax

Practice location:
  • Phone: 909-999-2340
  • Fax:
Mailing address:
  • Phone: 909-999-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MAKBULAHMED I PATEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 951-231-7247