Provider Demographics
NPI:1184030538
Name:CENTER OF COSMETICS AND GENERAL DENTISTRY
Entity Type:Organization
Organization Name:CENTER OF COSMETICS AND GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-263-8337
Mailing Address - Street 1:1213 RR 620 S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6340
Mailing Address - Country:US
Mailing Address - Phone:512-263-8337
Mailing Address - Fax:512-402-9558
Practice Address - Street 1:1213 RR 620 S
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6340
Practice Address - Country:US
Practice Address - Phone:512-263-8337
Practice Address - Fax:512-402-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty