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General NPI Number Information
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NPI Number | 1013441286
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Entity Type | Organization
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Legal Business Name | MYDENTAL AT NORWOOD PLLC
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 1045 NORWOOD PARK BLVD SUITE 103
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City | AUSTIN
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State | TX
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Zip | 78753
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Country | US
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Telephone | 512-815-3520
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Fax |
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Provider Business Mailing Address
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Address Line | 13000 N IH 35 STE 206
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City | AUSTIN
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State | TX
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Zip | 78753-1030
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Country | US
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Telephone | 512-815-2524
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Fax | 512-591-0768
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Authorized Official
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Title or Position | OWNER
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Name | JINAL PATEL
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Credential | DDS
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Telephone | 512-815-3520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30189
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License Number State | TX
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