Provider Demographics
NPI:1730287418
Name:PATEL, JAYANTILAL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAYANTILAL
Middle Name:G
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 1:8131 E. ROSECRANS AVE
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723
Mailing Address - Country:US
Mailing Address - Phone:562-634-2984
Mailing Address - Fax:562-634-2986
Practice Address - Street 1:8131 E. ROSECRANS AVE
Practice Address - Street 2:SUITE # 101
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723
Practice Address - Country:US
Practice Address - Phone:562-634-2984
Practice Address - Fax:562-634-2986
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB 28605-01OtherMEDICAL PROVIDER NUMBER