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General NPI Number Information
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NPI Number | 1316326374
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Entity Type | Individual
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Provider Name | KETAN PATEL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 3844 LAMAR AVE
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City | PARIS
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State | TX
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Zip | 75462-0001
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Country | US
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Telephone | 903-609-8840
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Fax |
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Provider Business Mailing Address
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Address Line | 401 BOYD DR #5305
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City | GRAPEVINE
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State | TX
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Zip | 76051-6355
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Country | US
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Telephone | 817-739-5617
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 32434
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License Number State | TX
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