Provider Demographics
NPI:1659401743
Name:PATEL, JIGNESH G (DDS)
Entity Type:Individual
Prefix:
First Name:JIGNESH
Middle Name:G
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 1:6580 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1426
Mailing Address - Country:US
Mailing Address - Phone:818-787-0701
Mailing Address - Fax:818-787-0172
Practice Address - Street 1:6580 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1426
Practice Address - Country:US
Practice Address - Phone:818-787-0701
Practice Address - Fax:818-787-0172
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42395-01Medicare ID - Type Unspecified