Provider Demographics
NPI:1114482239
Name:INDRAVADAN D PATEL DDS INC
Entity Type:Organization
Organization Name:INDRAVADAN D PATEL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:INDRAVADAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-520-4541
Mailing Address - Street 1:1018 E SYCAMORE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2165
Mailing Address - Country:US
Mailing Address - Phone:714-520-4541
Mailing Address - Fax:714-520-0453
Practice Address - Street 1:1018 E SYCAMORE ST STE 103
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2165
Practice Address - Country:US
Practice Address - Phone:714-520-4541
Practice Address - Fax:714-520-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-02
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental