Provider Demographics
NPI:1295102879
Name:PATEL, ANUJ (DDS)
Entity type:Individual
Prefix:DR
First Name:ANUJ
Middle Name:
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 1:3435 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#6793
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3653
Mailing Address - Country:US
Mailing Address - Phone:818-307-2743
Mailing Address - Fax:
Practice Address - Street 1:3435 E THOUSAND OAKS BLVD
Practice Address - Street 2:#6793
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-3653
Practice Address - Country:US
Practice Address - Phone:818-307-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65028122300000X
TX31422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist