Healthcare Provider Details

I. General information

NPI: 1518818335
Provider Name (Legal Business Name): SHIVALI PATEL DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

IV. Provider business mailing address

482 TRILLIUM CT
FAIRFIELD CA
94534-6933
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-7366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHIVALI PATEL
Title or Position: OWNER
Credential: DDS
Phone: 716-292-9031