=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235846379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILI PATEL DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2022
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17502 IRVINE BLVD STE B
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-3127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-306-6453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 HABITAT
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-8819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-306-6453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | DR. MILI R PATEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 646-306-6453
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------