=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407273592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANJANA A.PATEL,DDS.,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2014
-----------------------------------------------------
Last Update Date | 03/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2359 SKYLINE DR
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92831-1127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-747-1648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 W WILSHIRE AVE
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92832-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-871-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANJANA ARUN PATEL
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 814-747-1648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 38112
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------