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General NPI Number Information
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NPI Number | 1497209373
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Entity Type | Organization
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Legal Business Name | IDEAL DENTAL OF CLIFFORD CROSSING PLLC
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 515 W LOOP 820 N STE 101
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City | FORT WORTH
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State | TX
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Zip | 76108-1450
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Country | US
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Telephone | 817-916-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 12770 MERIT DR SUITE 850
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City | DALLAS
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State | TX
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Zip | 75251-1209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHALIN PATEL
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Credential | DDS
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Telephone | 972-331-8067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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