Healthcare Provider Details

I. General information

NPI: 1962199331
Provider Name (Legal Business Name): RKPDENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N GALLOWAY AVE STE 158
MESQUITE TX
75150-4701
US

IV. Provider business mailing address

4526 DEERE ST APT 204
DALLAS TX
75204-3471
US

V. Phone/Fax

Practice location:
  • Phone: 352-239-2177
  • Fax:
Mailing address:
  • Phone: 352-239-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAHUL PATEL
Title or Position: OWNER
Credential: DMD
Phone: 352-239-2177