Healthcare Provider Details

I. General information

NPI: 1053632703
Provider Name (Legal Business Name): ACCESS ORTHODONTICS OF WEST, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6018 WEST AVE SUITE #2
CASTLE HILLS TX
78213-2729
US

IV. Provider business mailing address

6018 WEST AVE SUITE #2
CASTLE HILLS TX
78213-2729
US

V. Phone/Fax

Practice location:
  • Phone: 210-979-8478
  • Fax:
Mailing address:
  • Phone: 210-979-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number23218
License Number StateTX

VIII. Authorized Official

Name: ANURAG PATEL
Title or Position: OWNER
Credential: DMD
Phone: 210-979-8478