Provider Demographics
NPI:1417075763
Name:PATEL, SARJU BHASKERRAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARJU
Middle Name:BHASKERRAO
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 1:15706 POMERADO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2067
Mailing Address - Country:US
Mailing Address - Phone:858-674-5252
Mailing Address - Fax:858-674-5255
Practice Address - Street 1:15706 POMERADO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2067
Practice Address - Country:US
Practice Address - Phone:858-674-5252
Practice Address - Fax:858-674-5255
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice