Provider Demographics
NPI:1588875967
Name:PANKAJ K. PATEL, DMD & SHAILESH K. PATEL, DDS A PROF CORP
Entity type:Organization
Organization Name:PANKAJ K. PATEL, DMD & SHAILESH K. PATEL, DDS A PROF CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CASSARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-543-9299
Mailing Address - Street 1:5712 PIRRONE RD
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-9313
Mailing Address - Country:US
Mailing Address - Phone:209-543-9299
Mailing Address - Fax:209-543-9699
Practice Address - Street 1:5712 PIRRONE RD
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CA
Practice Address - Zip Code:95368-9313
Practice Address - Country:US
Practice Address - Phone:209-543-9299
Practice Address - Fax:209-543-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental