MEDICARE: DR. SHIVAM PATEL DDS

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	1223P0221X	Pediatric Dentistry	40315	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225784705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIVAM PATEL DDS

Provider Business Mailing Address
First Line	:	11831 CULEBRA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4578
Country	:	US
Telephone Number	:	210-625-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	11831 CULEBRA RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-4578
Country	:	US
Telephone Number	:	210-625-5353
Fax Number	:

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

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	06/17/2024

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