MEDICARE: PANKTI PATEL D.D.S.

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	29186	TX

General Provider Information

NPI Number	:	1306286281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PANKTI PATEL D.D.S.

Provider Business Mailing Address
First Line	:	3030 LBJ FWY
Second Line	:	SUITE 1400
City	:	DALLAS
State	:	TX
Zip	:	75234-7781
Country	:	US
Telephone Number	:	972-663-5314
Fax Number	:

Provider Business Practice Location Address
First Line	:	3032 FM 720 WEST
Second Line	:
City	:	OAK POINT
State	:	TX
Zip	:	75068
Country	:	US
Telephone Number	:	469-598-1023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	07/15/2022

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