Provider Demographics
NPI:1053789826
Name:RM PATEL DDS, INC.
Entity type:Organization
Organization Name:RM PATEL DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYURKUMAR
Authorized Official - Middle Name:RATILAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-267-0970
Mailing Address - Street 1:7211 HAVEN AVE
Mailing Address - Street 2:STE # D
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6064
Mailing Address - Country:US
Mailing Address - Phone:909-256-8484
Mailing Address - Fax:909-256-8493
Practice Address - Street 1:7211 HAVEN AVE
Practice Address - Street 2:STE # D
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-6064
Practice Address - Country:US
Practice Address - Phone:909-256-8484
Practice Address - Fax:909-256-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54570122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty