Healthcare Provider Details

I. General information

NPI: 1760309702
Provider Name (Legal Business Name): BANSARI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 US HIGHWAY 271 N # 100
GILMER TX
75644-5580
US

IV. Provider business mailing address

879 US HIGHWAY 271 N # 100
GILMER TX
75644-5580
US

V. Phone/Fax

Practice location:
  • Phone: 903-680-2051
  • Fax:
Mailing address:
  • Phone: 903-680-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42548
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: