=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427190743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRAVINA PATEL DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 HILLCROFT ST STE D6
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-781-1170
-----------------------------------------------------
Fax | 713-781-6659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5901 HILLCROFT ST STE D6
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-781-1170
-----------------------------------------------------
Fax | 713-781-6659
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 20764
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------