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General NPI Number Information
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NPI Number | 1386817328
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Entity Type | Organization
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Legal Business Name | JAGRUTI PATEL DDS, A PROF. CORP.
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 12750 CARMEL COUNTRY RD SUITE 114A
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City | SAN DIEGO
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State | CA
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Zip | 92130-2159
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Country | US
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Telephone | 858-792-2511
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Fax | 858-792-4121
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Provider Business Mailing Address
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Address Line | 12750 CARMEL COUNTRY RD SUITE 114A
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City | SAN DIEGO
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State | CA
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Zip | 92130-2159
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Country | US
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Telephone | 858-792-2511
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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. JAGRUTI PATEL
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Credential | DDS
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Telephone | 760-720-9196
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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 | 36105
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License Number State | CA
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