Healthcare Provider Details

I. General information

NPI: 1780061119
Provider Name (Legal Business Name): RECONSTRUCTIVE SURGEONS OF KATY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 PARK GROVE DR STE A
KATY TX
77450-1571
US

IV. Provider business mailing address

464 PARK GROVE DR STE A
KATY TX
77450-1571
US

V. Phone/Fax

Practice location:
  • Phone: 281-394-9674
  • Fax: 281-394-9683
Mailing address:
  • Phone: 281-394-9674
  • Fax: 281-394-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberP5238
License Number StateTX

VIII. Authorized Official

Name: DIPAN DAS
Title or Position: OWNER/PROVIDER
Credential:
Phone: 832-232-4263