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General NPI Number Information
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NPI Number | 1265697239
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Entity Type | Organization
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Legal Business Name | PATEL DENTAL CORP,
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 4180 E FLORIDA AVE
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City | HEMET
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State | CA
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Zip | 92544-5079
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Country | US
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Telephone | 951-306-0987
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 E FLORIDA AVE
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City | HEMET
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State | CA
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Zip | 92544-5079
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Country | US
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Telephone | 951-306-0987
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAILESH K PATEL
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Credential | DDS
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Telephone | 951-551-4217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40705
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License Number State | CA
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