Provider Demographics
NPI:1972531754
Name:PATEL, VIMAL M (DDS)
Entity Type:Individual
Prefix:
First Name:VIMAL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E STETSON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7177
Mailing Address - Country:US
Mailing Address - Phone:951-652-9696
Mailing Address - Fax:951-652-5757
Practice Address - Street 1:240 E STETSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7177
Practice Address - Country:US
Practice Address - Phone:951-652-9696
Practice Address - Fax:951-652-5757
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice