Provider Demographics
NPI:1760161129
Name:PATEL, RUTVA DHARMENDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTVA
Middle Name:DHARMENDRA
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 GRANVILLE ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8872
Mailing Address - Country:US
Mailing Address - Phone:302-257-8853
Mailing Address - Fax:
Practice Address - Street 1:2801 COFFEE RD BLDG B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1756
Practice Address - Country:US
Practice Address - Phone:209-578-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty