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General NPI Number Information
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NPI Number | 1336287622
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Entity Type | Organization
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Legal Business Name | DESAR AND PATEL PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 19510 VAN BUREN BLVD F 5
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City | RIVERSIDE
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State | CA
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Zip | 92508-9457
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Country | US
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Telephone | 951-653-6663
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Fax | 951-656-5638
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Provider Business Mailing Address
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Address Line | 19510 VAN BUREN BLVD F 5
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City | RIVERSIDE
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State | CA
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Zip | 92508-9457
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Country | US
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Telephone | 951-653-6663
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Fax | 951-656-5638
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Authorized Official
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Title or Position | OWNER
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Name | DR. JYOTI V DESAR
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Credential | DDS
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Telephone | 951-653-6663
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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 | 41395
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License Number State | CA
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