Healthcare Provider Details

I. General information

NPI: 1588875967
Provider Name (Legal Business Name): PANKAJ K. PATEL, DMD & SHAILESH K. PATEL, DDS A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
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: 209-543-9699
Mailing address:
  • Phone: 209-543-9299
  • Fax: 209-543-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LEE CASSARA
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 209-543-9299