Provider Demographics
NPI:1194746933
Name:PATEL, PRADIP D (DDS)
Entity type:Individual
Prefix:MR
First Name:PRADIP
Middle Name:D
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 1:7501 ATLANTIC AVE
Mailing Address - Street 2:SUITE # C
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6804
Mailing Address - Country:US
Mailing Address - Phone:323-771-1706
Mailing Address - Fax:323-771-1299
Practice Address - Street 1:7501 ATLANTIC AVE
Practice Address - Street 2:SUITE # C
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-6804
Practice Address - Country:US
Practice Address - Phone:323-771-1706
Practice Address - Fax:323-771-1299
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331361223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist