Provider Demographics
NPI:1104279116
Name:TIM J PATEL DDS INC
Entity type:Organization
Organization Name:TIM J PATEL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-945-7366
Mailing Address - Street 1:1818 SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8606
Mailing Address - Country:US
Mailing Address - Phone:925-945-7366
Mailing Address - Fax:925-210-1287
Practice Address - Street 1:1818 SAN MIGUEL DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8606
Practice Address - Country:US
Practice Address - Phone:925-945-7366
Practice Address - Fax:925-210-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty