Provider Demographics
NPI:1679728943
Name:PATEL, TARUN BALLUBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARUN
Middle Name:BALLUBHAI
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 1:17716 TULSA ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4528
Mailing Address - Country:US
Mailing Address - Phone:818-675-3330
Mailing Address - Fax:
Practice Address - Street 1:13279 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3003
Practice Address - Country:US
Practice Address - Phone:818-899-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-29
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist