MEDICARE: DR. ANURAG RAMESH PATEL DMD, MSED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	19025519	IL
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	23218	TX

General Provider Information

NPI Number	:	1144297953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANURAG RAMESH PATEL DMD, MSED

Provider Business Mailing Address
First Line	:	4120 HERITAGE TRACE PKWY
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5308
Country	:	US
Telephone Number	:	817-431-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 HERITAGE TRACE PKWY
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5308
Country	:	US
Telephone Number	:	817-431-0707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	10/24/2011

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