Provider Demographics
NPI:1710657622
Name:PATEL, MOHINI (DMD)
Entity Type:Individual
Prefix:
First Name:MOHINI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MOHINI
Other - Middle Name:
Other - Last Name:CHOKHAWALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1589 LIVE OAK RD APT 94
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-5419
Mailing Address - Country:US
Mailing Address - Phone:309-531-3358
Mailing Address - Fax:
Practice Address - Street 1:1350 E VISTA WAY STE 10
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4037
Practice Address - Country:US
Practice Address - Phone:760-208-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist