MEDICARE: DIPTI M. PATEL, DDS, INC

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	43231	CA

General Provider Information

NPI Number	:	1831412279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIPTI M. PATEL, DDS, INC

Provider Business Mailing Address
First Line	:	14940 PERRIS BLVD
Second Line	:	C
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-7183
Country	:	US
Telephone Number	:	951-242-0041
Fax Number	:	951-242-9816

Provider Business Practice Location Address
First Line	:	4028 CHICAGO AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5340
Country	:	US
Telephone Number	:	951-328-1166
Fax Number	:	951-328-1160

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIPTI M PATEL
Credential	:	DDS
Telephone Number	:	951-242-0041

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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