Provider Demographics
NPI:1548608425
Name:PATEL, AJAYKUMAR N (DDS)
Entity Type:Individual
Prefix:
First Name:AJAYKUMAR
Middle Name:N
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 1:3430 TULLY RD STE 21
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0840
Mailing Address - Country:US
Mailing Address - Phone:209-422-6176
Mailing Address - Fax:
Practice Address - Street 1:3430 TULLY RD STE 21
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0840
Practice Address - Country:US
Practice Address - Phone:209-422-6176
Practice Address - Fax:209-661-4919
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice