Provider Demographics
NPI:1760524656
Name:PATEL, BHAVNA Y (DDS)
Entity Type:Individual
Prefix:MRS
First Name:BHAVNA
Middle Name:Y
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 1:511 GIOTTO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8578
Mailing Address - Country:US
Mailing Address - Phone:949-439-7191
Mailing Address - Fax:
Practice Address - Street 1:1715 W REDLANDS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8012
Practice Address - Country:US
Practice Address - Phone:909-801-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice