Provider Demographics
NPI:1487111985
Name:PATEL, MITTAL ASHOKKUMAR (DDS)
Entity type:Individual
Prefix:
First Name:MITTAL
Middle Name:ASHOKKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 SANTA FIORA DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-1113
Mailing Address - Country:US
Mailing Address - Phone:978-394-5197
Mailing Address - Fax:
Practice Address - Street 1:2083 COMPTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7288
Practice Address - Country:US
Practice Address - Phone:951-737-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist