Healthcare Provider Details

I. General information

NPI: 1285642017
Provider Name (Legal Business Name): PATRICK M RALPH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11921 BISSONNET ST
HOUSTON TX
77099-1425
US

IV. Provider business mailing address

11921 BISSONNET ST
HOUSTON TX
77099-1425
US

V. Phone/Fax

Practice location:
  • Phone: 281-495-3343
  • Fax: 281-495-1125
Mailing address:
  • Phone: 281-495-3343
  • Fax: 281-495-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number20140
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: