Provider Demographics
NPI:1023390879
Name:VAKIL, PRATIK MANOJ (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:MANOJ
Last Name:VAKIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14637 MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-7519
Mailing Address - Country:US
Mailing Address - Phone:832-259-4006
Mailing Address - Fax:281-406-8167
Practice Address - Street 1:14637 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-7519
Practice Address - Country:US
Practice Address - Phone:832-259-4006
Practice Address - Fax:281-406-8167
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0558231223G0001X
TX292751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice