Provider Demographics
NPI:1760667364
Name:VAISHALI PATEL DDS, INC
Entity Type:Organization
Organization Name:VAISHALI PATEL DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-971-8178
Mailing Address - Street 1:207 W G ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-5405
Mailing Address - Country:US
Mailing Address - Phone:310-549-2400
Mailing Address - Fax:310-834-0634
Practice Address - Street 1:207 W G ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-5405
Practice Address - Country:US
Practice Address - Phone:310-549-2400
Practice Address - Fax:310-834-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA499731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG89646-01OtherDENTI CAL PROVIDER ID