Provider Demographics
NPI:1700324977
Name:PATEL, BHUMIBEN P
Entity Type:Individual
Prefix:
First Name:BHUMIBEN
Middle Name:P
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18170 CHIEFTAIN CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3121
Mailing Address - Country:US
Mailing Address - Phone:858-381-7817
Mailing Address - Fax:
Practice Address - Street 1:18170 CHIEFTAIN CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3121
Practice Address - Country:US
Practice Address - Phone:858-381-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist