Provider Demographics
NPI:1932312139
Name:PATEL, SHIRISH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 E WASHINGTON ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4715
Mailing Address - Country:US
Mailing Address - Phone:909-824-1188
Mailing Address - Fax:
Practice Address - Street 1:2049 E WASHINGTON ST STE 2F
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4715
Practice Address - Country:US
Practice Address - Phone:909-824-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA364101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice