Healthcare Provider Details

I. General information

NPI: 1184136343
Provider Name (Legal Business Name): MEGHA Y PATHAK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 ADDISON PL
SUGAR LAND TX
77479-5200
US

IV. Provider business mailing address

114 ADDISON PL
SUGAR LAND TX
77479-5200
US

V. Phone/Fax

Practice location:
  • Phone: 407-883-0331
  • Fax:
Mailing address:
  • Phone: 407-883-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number32893
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: