Provider Demographics
NPI:1154003044
Name:PATEL, VIVEK SANDEEP (DMD)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:SANDEEP
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5666
Mailing Address - Country:US
Mailing Address - Phone:714-507-0480
Mailing Address - Fax:
Practice Address - Street 1:403 W IMPERIAL HWY STE 102
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4801
Practice Address - Country:US
Practice Address - Phone:714-252-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist