Provider Demographics
NPI:1659526366
Name:PATEL, INDRAVADAN DAHYABHAI (DDS)
Entity Type:Individual
Prefix:
First Name:INDRAVADAN
Middle Name:DAHYABHAI
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 1:1018 E SYCAMORE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2165
Mailing Address - Country:US
Mailing Address - Phone:714-520-4541
Mailing Address - Fax:714-520-4543
Practice Address - Street 1:1018 E SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2165
Practice Address - Country:US
Practice Address - Phone:714-520-4541
Practice Address - Fax:714-520-4543
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDO35153122300000X
CAD35153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist