MEDICARE: SANDEEP B. PATEL, D.D.S., P.A.

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
1	122300000X	Dentist	21274	TX

General Provider Information

NPI Number	:	1215015292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDEEP B. PATEL, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	11215 S. IH-35
Second Line	:	SUITE#116
City	:	AUSTIN
State	:	TX
Zip	:	78747
Country	:	US
Telephone Number	:	512-233-6200
Fax Number	:	512-233-6201

Provider Business Practice Location Address
First Line	:	411 BRAZOS ST
Second Line	:	UNIT #206
City	:	AUSTIN
State	:	TX
Zip	:	78701-3698
Country	:	US
Telephone Number	:	512-233-6200
Fax Number	:	512-233-6201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANDEEP B PATEL
Credential	:	D.D.S.
Telephone Number	:	512-233-6200

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/18/2008

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