=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437913530
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MITTAL PATEL DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2024
-----------------------------------------------------
Last Update Date | 02/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2083 COMPTON AVE
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92881-7283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-737-4515
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2747 SANTA FIORA DR
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92882-1113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-394-5197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MITTAL PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-394-5197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------