=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376925420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMIT M PATEL, DDS, MSD, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2015
-----------------------------------------------------
Last Update Date | 06/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2440 N JOSEY LN SUITE 202
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-242-7603
-----------------------------------------------------
Fax | 972-242-0925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2440 N JOSEY LN SUITE 202
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-1668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-242-7603
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / DOCTOR
-----------------------------------------------------
Name | DR. AMIT M PATEL
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 972-242-7603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 26053
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------