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General NPI Number Information
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NPI Number | 1952277261
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Entity Type | Individual
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Provider Name | SHIVAM PATEL
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Gender | Male
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 2733 FORT WORTH HWY STE 101
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City | HUDSON OAKS
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State | TX
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Zip | 76087-4924
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Country | US
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Telephone | 682-333-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 STATE HIGHWAY 26 APT 2157
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City | GRAPEVINE
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State | TX
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Zip | 76051-2160
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Country | US
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Telephone | 601-329-5472
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 42025
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License Number State | TX
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