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General NPI Number Information
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NPI Number | 1114482239
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Entity Type | Organization
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Legal Business Name | INDRAVADAN D PATEL DDS INC
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Dates
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Enumeration Date | 02/02/2019
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Last Update Date | 04/06/2019
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Provider Practice Location Address
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Address Line | 1018 E SYCAMORE ST STE 103
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City | ANAHEIM
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State | CA
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Zip | 92805-2165
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Country | US
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Telephone | 714-520-4541
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Fax | 714-520-4543
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Provider Business Mailing Address
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Address Line | 1018 E SYCAMORE ST STE 103
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City | ANAHEIM
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State | CA
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Zip | 92805-2165
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Country | US
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Telephone | 714-520-4541
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Fax | 714-520-0453
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Authorized Official
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Title or Position | DENTIST
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Name | INDRAVADAN D PATEL
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Credential | DDS
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Telephone | 714-520-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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