Provider Demographics
NPI:1831259688
Name:PATEL, MANDEEP DILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:DILIP
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 1:10757 LEMON AVE APT 1328
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-6948
Mailing Address - Country:US
Mailing Address - Phone:951-907-1710
Mailing Address - Fax:
Practice Address - Street 1:15290-B BEAR VALLEY ROAD (AT BALSAM AVE)
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392
Practice Address - Country:US
Practice Address - Phone:760-951-7777
Practice Address - Fax:760-951-1582
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist