MEDICARE: DR. DEEP PARIKH MDS

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	32658	TX

General Provider Information

NPI Number	:	1689113201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEP PARIKH MDS

Provider Business Mailing Address
First Line	:	4511 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4511 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2628
Country	:	US
Telephone Number	:	817-918-3343
Fax Number	:

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

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	02/15/2017

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