Provider Demographics
NPI:1063894160
Name:PATEL, SHAILAIN R (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAILAIN
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHAILAIN
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3120 BALFOUR RD STE D
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5514
Mailing Address - Country:US
Mailing Address - Phone:925-634-4040
Mailing Address - Fax:
Practice Address - Street 1:3120 BALFOUR RD STE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5514
Practice Address - Country:US
Practice Address - Phone:925-634-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice