Provider Demographics
NPI:1962517391
Name:PATEL, SHILPA SHIVASHANKAR (DDS)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:SHIVASHANKAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHILPA
Other - Middle Name:
Other - Last Name:SHIVASHANKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2145 STANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9051
Mailing Address - Country:US
Mailing Address - Phone:904-476-6879
Mailing Address - Fax:
Practice Address - Street 1:2145 STANSFIELD DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-9051
Practice Address - Country:US
Practice Address - Phone:904-476-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD70361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice