Provider Demographics
NPI:1336295773
Name:PATEL, DIPTI M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIPTI
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14940 PERRIS BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-7183
Mailing Address - Country:US
Mailing Address - Phone:951-242-0041
Mailing Address - Fax:951-242-9816
Practice Address - Street 1:14940 PERRIS BLVD
Practice Address - Street 2:STE C
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-7183
Practice Address - Country:US
Practice Address - Phone:951-242-0041
Practice Address - Fax:951-242-9816
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice