MEDICARE: DR. PRASHANTA PATEL DDS MPH FICOI

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	122300000X	Dentist	016.0134076	VT
2	122300000X	Dentist	D011671	AZ

General Provider Information

NPI Number	:	1760157069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRASHANTA PATEL DDS MPH FICOI

Provider Business Mailing Address
First Line	:	707 PARNASSUS AVE # 75
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2827 W PEORIA AVE STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-5213
Country	:	US
Telephone Number	:	602-749-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	07/13/2023

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