Provider Demographics
NPI:1629622022
Name:PATEL, SHANE BIRJU (DDS)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:BIRJU
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 1:2649 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3239
Mailing Address - Country:US
Mailing Address - Phone:714-771-2600
Mailing Address - Fax:714-771-0901
Practice Address - Street 1:2649 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3239
Practice Address - Country:US
Practice Address - Phone:714-771-2600
Practice Address - Fax:714-771-0901
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104154122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist