Provider Demographics
NPI:1235304668
Name:PATEL, MUKESH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MUKESHBHAI
Other - Middle Name:BHULABHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:974 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-2113
Mailing Address - Country:US
Mailing Address - Phone:909-414-3535
Mailing Address - Fax:
Practice Address - Street 1:974 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2113
Practice Address - Country:US
Practice Address - Phone:909-414-3535
Practice Address - Fax:909-510-4556
Is Sole Proprietor?:No
Enumeration Date:2008-04-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist