Provider Demographics
NPI:1083969109
Name:PATEL, SHIVANI TAPAN (DMD)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:TAPAN
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:AMUL
Other - Last Name:PANDYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1761 S LOOP 336 W STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3391
Mailing Address - Country:US
Mailing Address - Phone:936-788-1919
Mailing Address - Fax:
Practice Address - Street 1:1761 S LOOP 336 W STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3391
Practice Address - Country:US
Practice Address - Phone:936-788-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0393321223G0001X
MADN18560771223G0001X
TX286001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice