Provider Demographics
NPI:1962557173
Name:PATEL, DEVANGKUMAR J
Entity type:Individual
Prefix:
First Name:DEVANGKUMAR
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 W VALLEY BLVD
Mailing Address - Street 2:SUIT #C
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2001
Mailing Address - Country:US
Mailing Address - Phone:909-824-7060
Mailing Address - Fax:909-824-7066
Practice Address - Street 1:895 WEST VALLEY BLVD
Practice Address - Street 2:SUIT #C
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-824-7060
Practice Address - Fax:909-824-7066
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice