Provider Demographics
NPI:1699822718
Name:PATEL, PRAFUL N (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRAFUL
Middle Name:N
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PRAFULCHANDRA
Other - Middle Name:NARANBHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9825 LONG BEACH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-4100
Mailing Address - Country:US
Mailing Address - Phone:323-249-4444
Mailing Address - Fax:323-249-4364
Practice Address - Street 1:9825 LONG BEACH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-4100
Practice Address - Country:US
Practice Address - Phone:323-249-4444
Practice Address - Fax:323-249-4364
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice