Provider Demographics
NPI:1740392521
Name:PATEL, PARITOSH (DDS)
Entity Type:Individual
Prefix:
First Name:PARITOSH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PERRY
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:901 OAK PARK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449
Mailing Address - Country:US
Mailing Address - Phone:805-489-4761
Mailing Address - Fax:805-489-8235
Practice Address - Street 1:901 OAK PARK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449
Practice Address - Country:US
Practice Address - Phone:805-489-4761
Practice Address - Fax:805-489-8235
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist