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NPI Code Detail

MEDICARE: SYNERGY DENTAL, LLC

MEDICARE: SYNERGY DENTAL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist24395TX

General Provider Information

NPI Number : 1124372016
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYNERGY DENTAL, LLC
Provider Business Mailing Address
First Line : 4401 RIVER VALLEY DR
Second Line : APT. 605
City : CORPUS CHRISTI
State : TX
Zip : 78410-5250
Country : US
Telephone Number : 201-895-9021
Fax Number : 361-767-8802
Provider Business Practice Location Address
First Line : 109 E AVENUE J
Second Line :
City : ROBSTOWN
State : TX
Zip : 78380-2347
Country : US
Telephone Number : 361-387-1531
Fax Number : 361-767-8802
Authorized Official
Title or Position : PRESIDENT
Name : DR. PURAVKUMAR DESAI
Credential : DDS
Telephone Number : 201-895-9021
Provider Enumeration Date : 10/31/2012
Last Update Date : 10/31/2012

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Directions to “SYNERGY DENTAL, LLC ” Practice Location

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