MEDICARE: PRATIK C PATEL DDS

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	35708	TX
2	1223G0001X	General Practice Dentistry	35708	TX
3	122300000X	Dentist	7384	LA

General Provider Information

NPI Number	:	1669021804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATIK C PATEL DDS

Provider Business Mailing Address
First Line	:	2625 DILLARD LOOP STE A
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-7721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 DILLARD LOOP STE A
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-7721
Country	:	US
Telephone Number	:	409-363-3244
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	02/24/2025

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