Provider Demographics
NPI:1578687570
Name:PATEL, PANKAJ K (DMD)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:K
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 PIRRONE RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9313
Mailing Address - Country:US
Mailing Address - Phone:209-543-9299
Mailing Address - Fax:209-543-9699
Practice Address - Street 1:5712 PIRRONE RD
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9313
Practice Address - Country:US
Practice Address - Phone:209-543-9299
Practice Address - Fax:209-543-9699
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD45169Medicaid