Provider Demographics
NPI:1538544887
Name:PATEL, TEJAL P
Entity type:Individual
Prefix:
First Name:TEJAL
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 1:38427 5TH ST W
Mailing Address - Street 2:G128
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4276
Mailing Address - Country:US
Mailing Address - Phone:845-837-9540
Mailing Address - Fax:
Practice Address - Street 1:23130 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2631
Practice Address - Country:US
Practice Address - Phone:845-837-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA647181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice