Healthcare Provider Details

I. General information

NPI: 1558587121
Provider Name (Legal Business Name): SHAILESH PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5712 PIRRONE RD
SALIDA CA
95368-9313
US

IV. Provider business mailing address

5712 PIRRONE RD
SALIDA CA
95368-9313
US

V. Phone/Fax

Practice location:
  • Phone: 209-543-9299
  • Fax:
Mailing address:
  • Phone: 209-543-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD40705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: