Provider Demographics
NPI:1255537155
Name:PATEL, HEMANTKUMAR V
Entity type:Individual
Prefix:
First Name:HEMANTKUMAR
Middle Name:V
Last Name:PATEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N BENSON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5076
Mailing Address - Country:US
Mailing Address - Phone:909-949-4070
Mailing Address - Fax:909-949-3005
Practice Address - Street 1:615 N BENSON AVE STE F
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5076
Practice Address - Country:US
Practice Address - Phone:909-949-4070
Practice Address - Fax:909-949-3005
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB29647-01Medicare ID - Type UnspecifiedDENTICAL