Provider Demographics
NPI:1164630919
Name:PATEL, TUSHAR B (DDS)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:B
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 1:1301 W ARROW HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2330
Mailing Address - Country:US
Mailing Address - Phone:909-394-5500
Mailing Address - Fax:909-394-7700
Practice Address - Street 1:1301 W ARROW HWY STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2330
Practice Address - Country:US
Practice Address - Phone:909-394-5500
Practice Address - Fax:909-394-7700
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA491801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics