Provider Demographics
NPI:1679694491
Name:PATEL, RITA VISHNU (DDS)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:VISHNU
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 MONTE VISTA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2234
Mailing Address - Country:US
Mailing Address - Phone:909-624-7222
Mailing Address - Fax:909-624-1893
Practice Address - Street 1:9625 MONTE VISTA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2234
Practice Address - Country:US
Practice Address - Phone:909-624-7222
Practice Address - Fax:909-624-1893
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice