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General NPI Number Information
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NPI Number | 1902506132
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Entity Type | Individual
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Provider Name | KUSHAL PATEL
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Gender | Male
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 917 E HIGHWAY 199
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City | SPRINGTOWN
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State | TX
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Zip | 76082-6039
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Country | US
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Telephone | 817-752-3938
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Fax |
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Provider Business Mailing Address
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Address Line | 703 MAPLEWOOD LN
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City | LUCAS
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State | TX
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Zip | 75002-7594
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Country | US
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Telephone | 469-215-6959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 40480
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License Number State | TX
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