Healthcare Provider Details

I. General information

NPI: 1972706463
Provider Name (Legal Business Name): KETAN PAREKH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 WEST RALPH HALL PKWY
ROCKWALL TX
75032-6660
US

IV. Provider business mailing address

960 WEST RALPH HALL PKWY
ROCKWALL TX
75032-6660
US

V. Phone/Fax

Practice location:
  • Phone: 469-498-9800
  • Fax: 469-698-9804
Mailing address:
  • Phone: 469-698-9800
  • Fax: 469-698-9804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2169
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number23679
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: