Healthcare Provider Details

I. General information

NPI: 1699954552
Provider Name (Legal Business Name): RAJIV PATEL ENDODONTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N MAPLE ST
MUENSTER TX
76252-2425
US

IV. Provider business mailing address

9241 BLANCO DR
LANTANA TX
76226-7328
US

V. Phone/Fax

Practice location:
  • Phone: 940-759-2303
  • Fax: 940-759-2399
Mailing address:
  • Phone: 940-725-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number23175
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: