=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417085242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINNARI PRAJAPATI, D.D.S., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1618 CANYON CREEK DR SUITE 110
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502-3275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-771-5900
-----------------------------------------------------
Fax | 254-771-5380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7718 BUCKMEADOW DR
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78628-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-869-8300
-----------------------------------------------------
Fax | 512-869-8300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KINNARI PRAJAPATI
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 254-771-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 20617
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------