Healthcare Provider Details

I. General information

NPI: 1326499393
Provider Name (Legal Business Name): KUNTAL PATEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WILLIAM CANNON DR SUITE #201
AUSTIN TX
78745-6646
US

IV. Provider business mailing address

4646 MUELLER BLVD APT. #4075
AUSTIN TX
78723-3000
US

V. Phone/Fax

Practice location:
  • Phone: 512-717-5353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31927
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: