Healthcare Provider Details

I. General information

NPI: 1669906590
Provider Name (Legal Business Name): DILLON PATEL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 12/24/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 S LAMAR BLVD APT 1086
AUSTIN TX
78704-0139
US

IV. Provider business mailing address

2717 SOUTH LAMAR BLVD #1086
AUSTIN TX
78704
US

V. Phone/Fax

Practice location:
  • Phone: 512-717-5315
  • Fax:
Mailing address:
  • Phone: 512-717-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35621
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: