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General NPI Number Information
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NPI Number | 1356658702
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Entity Type | Organization
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Legal Business Name | SANJAY V PATEL DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 415 W 5TH ST STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1325
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Country | US
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Telephone | 909-386-7878
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Fax | 909-386-7881
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Provider Business Mailing Address
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Address Line | 415 W 5TH ST STE B
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City | SAN BERNARDINO
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State | CA
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Zip | 92401-1325
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Country | US
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Telephone | 909-386-7878
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Fax | 909-386-7881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANJAY VASANGEE PATEL
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Credential | DDS
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Telephone | 909-386-7878
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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 | 43480
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License Number State | CA
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