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NPI Code Detail

MEDICARE: STAVAN YOGENDRA PATEL DDS, MD

MEDICARE:   STAVAN YOGENDRA PATEL  DDS, MD
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
1204E00000XOral & Maxillofacial Surgery (D.M.D.)U0177TX
2204E00000XOral & Maxillofacial Surgery (D.M.D.)MD.302913LA

General Provider Information

NPI Number : 1558688309
Entity Type Code : Individual
Provider Name (Legal Business Name) : STAVAN YOGENDRA PATEL DDS, MD
Provider Business Mailing Address
First Line : 2508 BERT KOUNS INDUSTRIAL LOOP STE 410
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-3157
Country : US
Telephone Number : 318-212-5944
Fax Number : 318-212-5949
Provider Business Practice Location Address
First Line : 2508 BERT KOUNS INDUSTRIAL LOOP STE 410
Second Line :
City : SHREVEPORT
State : LA
Zip : 71118-3157
Country : US
Telephone Number : 318-212-5944
Fax Number : 318-212-5949
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2010
Last Update Date : 11/21/2024

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Directions to “ STAVAN YOGENDRA PATEL DDS, MD” Practice Location

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