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General NPI Number Information
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NPI Number | 1740540087
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Entity Type | Organization
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Legal Business Name | ACCESS ORTHODONTICS OF ILLINOIS PA
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 2304 W ILLINOIS AVE
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City | DALLAS
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State | TX
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Zip | 75224-1638
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Country | US
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Telephone | 214-337-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 2304 W ILLINOIS AVE
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City | DALLAS
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State | TX
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Zip | 75224-1638
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Country | US
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Telephone | 214-337-7200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANURAG R PATEL
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Credential | DMD
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Telephone | 214-337-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23218
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License Number State | TX
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