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General NPI Number Information
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NPI Number | 1790226587
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Entity Type | Organization
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Legal Business Name | STADIUM DENTAL PLLC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 1514 E ABRAM ST SUITE A
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City | ARLINGTON
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State | TX
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Zip | 76010-7213
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Country | US
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Telephone | 817-801-9500
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Fax | 817-801-9501
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Provider Business Mailing Address
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Address Line | 1930 E PARK ROW DR
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City | ARLINGTON
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State | TX
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Zip | 76010-4744
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Country | US
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Telephone | 817-801-9500
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Fax | 817-801-9501
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Authorized Official
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Title or Position | OWNER
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Name | HIREN A PATEL
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Credential | DDS
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Telephone | 817-801-9500
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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 | 27622
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License Number State | TX
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