MEDICARE: SHAH PATEL DENTAL PARTNERSHIP

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1083208961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAH PATEL DENTAL PARTNERSHIP

Provider Business Mailing Address
First Line	:	4911 WARNER AVE STE 202
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4473
Country	:	US
Telephone Number	:	714-846-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 WARNER AVE STE 202
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4473
Country	:	US
Telephone Number	:	714-846-4414
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. MANALI SHAH PATEL
Credential	:	D.D.S
Telephone Number	:	714-846-4414

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	03/15/2021

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