=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548140965
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY DILIPKUMAR PATEL BDS, MPH, CERTI ORTH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2025
-----------------------------------------------------
Last Update Date | 09/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9515 W GULF BANK RD APT 112
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77040-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-485-3298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9515 W GULF BANK RD APT 112
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77040-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-485-3298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 41948
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------