Healthcare Provider Details

I. General information

NPI: 1073996732
Provider Name (Legal Business Name): AMRUTA PATEL DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3357
US

IV. Provider business mailing address

8261 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3357
US

V. Phone/Fax

Practice location:
  • Phone: 210-342-2000
  • Fax: 210-342-2517
Mailing address:
  • Phone: 210-342-2000
  • Fax: 210-342-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number24784
License Number StateTX

VIII. Authorized Official

Name: DR. AMRUTA PATEL
Title or Position: PRESIDENT
Credential: DDS
Phone: 210-342-2000