| My Dentist | |
|
415 W 5th St Ste B San Bernardino CA 92401-1325 | |
| (909) 386-7878 | |
| (909) 386-7881 |
| Full Name | My Dentist |
|---|---|
| Speciality | Dentist |
| Location | 415 W 5th St Ste B, San Bernardino, California |
| Authorized Official Name and Position | Sanjay Vasangee Patel (PRESIDENT) |
| Authorized Official Contact | 9093867878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Dentist 415 W 5th St Ste B San Bernardino CA 92401-1325 Ph: (909) 386-7878 | My Dentist 415 W 5th St Ste B San Bernardino CA 92401-1325 Ph: (909) 386-7878 |
| NPI Number | 1356658702 |
|---|---|
| Provider Enumeration Date | 09/07/2010 |
| Last Update Date | 07/13/2021 |
| Medicare PECOS PAC ID | 9133520299 |
|---|---|
| Medicare Enrollment ID | O20210625002483 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356658702 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 43480 (California) | Primary |
| Provider Name | Sanjay V Patel |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1942216809 PECOS PAC ID: 8921307687 Enrollment ID: I20210713003001 |
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