Provider Demographics
NPI:1346656600
Name:PATEL, PRAGNESH JASHUBHAI
Entity Type:Individual
Prefix:DR
First Name:PRAGNESH
Middle Name:JASHUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 W 29TH ST
Mailing Address - Street 2:APT#5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3174
Mailing Address - Country:US
Mailing Address - Phone:516-353-8133
Mailing Address - Fax:
Practice Address - Street 1:44407 CHALLENGER WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3237
Practice Address - Country:US
Practice Address - Phone:661-341-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist