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NPI Code Detail

MEDICARE: BAUTISTA AND PATEL DENTAL

MEDICARE: BAUTISTA AND PATEL DENTAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1053982439
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAUTISTA AND PATEL DENTAL
Provider Business Mailing Address
First Line : PO BOX 920050
Second Line :
City : DALLAS
State : TX
Zip : 75392-0050
Country : US
Telephone Number : 714-845-8890
Fax Number : 303-952-0892
Provider Business Practice Location Address
First Line : 370 CODDINGTOWN CTR
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-3507
Country : US
Telephone Number : 707-867-1310
Fax Number : 707-921-1398
Authorized Official
Title or Position : OWNER
Name : VARSHA AHUJA
Credential : DMD
Telephone Number : 707-867-1310
Provider Enumeration Date : 07/07/2021
Last Update Date : 07/07/2021

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Directions to “BAUTISTA AND PATEL DENTAL ” Practice Location

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