Healthcare Provider Details

I. General information

NPI: 1932946472
Provider Name (Legal Business Name): VISHWASH PATEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 MARIN ST STE 220
THOUSAND OAKS CA
91360-4230
US

IV. Provider business mailing address

11284 JACOBSEN PL
MOORPARK CA
93021-8739
US

V. Phone/Fax

Practice location:
  • Phone: 805-374-8484
  • Fax:
Mailing address:
  • Phone: 330-968-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: