Provider Demographics
NPI:1790149193
Name:PATEL, PAYAL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:
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 1:13297 JAMBOREE RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9159
Mailing Address - Country:US
Mailing Address - Phone:714-730-6600
Mailing Address - Fax:951-776-1751
Practice Address - Street 1:13297 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-9159
Practice Address - Country:US
Practice Address - Phone:714-730-6600
Practice Address - Fax:951-776-1571
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1004541223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics