MEDICARE: MEHA 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	1223G0001X	General Practice Dentistry	019031717	IL
2	1223G0001X	General Practice Dentistry	36029	TX

General Provider Information

NPI Number	:	1922591247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHA PATEL DDS

Provider Business Mailing Address
First Line	:	5917 FAIRGLEN AVE APT 619
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5917 FAIRGLEN AVE APT 619
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6818
Country	:	US
Telephone Number	:	503-929-0891
Fax Number	:

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

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	02/17/2022

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