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General NPI Number Information
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NPI Number | 1538515580
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Entity Type | Organization
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Legal Business Name | ENAMEL DENTISTRY SOUTH LAMAR PLLC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 2717 S LAMAR BLVD SUITE 1086
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City | AUSTIN
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State | TX
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Zip | 78704-5044
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Country | US
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Telephone | 512-717-5315
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 S LAMAR BLVD SUITE 1086
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City | AUSTIN
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State | TX
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Zip | 78704-5044
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Country | US
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Telephone | 512-717-5315
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEVISHKUMAR PATEL
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Credential | DDS
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Telephone | 512-717-5315
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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 | 30046
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30081
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License Number State | TX
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