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General NPI Number Information
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NPI Number | 1114417151
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Entity Type | Organization
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Legal Business Name | SHARDA PATEL, DMD INC
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 1488 CEDARWOOD LN STE D
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City | PLEASANTON
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State | CA
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Zip | 94566-6125
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Country | US
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Telephone | 925-846-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 3036 BLACKBERRY AVE
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City | SAN RAMON
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State | CA
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Zip | 94582-5413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | SHARDA PATEL
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Credential | DMD
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Telephone | 714-924-4338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 63503
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License Number State | CA
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