Provider Demographics
NPI:1043586555
Name:PATEL, MITAL MUKESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITAL
Middle Name:MUKESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3230
Mailing Address - Country:US
Mailing Address - Phone:209-538-9297
Mailing Address - Fax:
Practice Address - Street 1:2561 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3230
Practice Address - Country:US
Practice Address - Phone:209-538-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist