MEDICARE: DR. TRISHA 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	34502	TX

General Provider Information

NPI Number	:	1821576521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRISHA PATEL DDS

Provider Business Mailing Address
First Line	:	2637 TOLEDO DR
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-4810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4541 HERITAGE TRACE PKWY STE 1301
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8921
Country	:	US
Telephone Number	:	912-484-3405
Fax Number	:

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

Provider Enumeration Date	:	08/03/2018
Last Update Date	:	02/25/2021

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