Healthcare Provider Details

I. General information

NPI: 1427334887
Provider Name (Legal Business Name): ROOT CANAL CLINIC OF NORTH TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MARTIN DR STE 200
BEDFORD TX
76021-6081
US

IV. Provider business mailing address

2201 MARTIN DR STE 200
BEDFORD TX
76021-6081
US

V. Phone/Fax

Practice location:
  • Phone: 817-438-2220
  • Fax: 817-439-6675
Mailing address:
  • Phone: 817-438-2220
  • Fax: 271-439-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number20123
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20123
License Number StateTX

VIII. Authorized Official

Name: DR. YOGESH THAKOR PATEL
Title or Position: OWNER / DOCTOR
Credential: D.D.S
Phone: 214-342-0425