Provider Demographics
NPI:1396899183
Name:PATEL, NANDAN BABUBHAI (DDS)
Entity type:Individual
Prefix:DR
First Name:NANDAN
Middle Name:BABUBHAI
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 1:801 OAKDALE ROAD
Mailing Address - Street 2:SUITE D-5
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-548-0100
Mailing Address - Fax:209-548-0400
Practice Address - Street 1:801 OAKDALE RD
Practice Address - Street 2:SUITE D-5
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4592
Practice Address - Country:US
Practice Address - Phone:209-548-0100
Practice Address - Fax:209-548-0400
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist