Healthcare Provider Details

I. General information

NPI: 1215462320
Provider Name (Legal Business Name): JAY PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 DEL PASO RD STE 142
SACRAMENTO CA
95834-7707
US

IV. Provider business mailing address

1954 DEL PASO RD STE 142
SACRAMENTO CA
95834-7707
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-6051
  • Fax: 916-921-6480
Mailing address:
  • Phone: 916-921-6051
  • Fax: 916-921-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041642
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111345
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS041642
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: