Provider Demographics
NPI:1417152406
Name:PATEL, AMIT INDRAVADAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:INDRAVADAN
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 1:1835 RAMONA DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8482
Mailing Address - Country:US
Mailing Address - Phone:805-302-1998
Mailing Address - Fax:805-383-3541
Practice Address - Street 1:1835 RAMONA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8482
Practice Address - Country:US
Practice Address - Phone:805-302-1998
Practice Address - Fax:805-204-7593
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50507122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist