Provider Demographics
NPI:1184181257
Name:MYDENTAL AT ROUND ROCK PLLC
Entity Type:Organization
Organization Name:MYDENTAL AT ROUND ROCK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-675-0808
Mailing Address - Street 1:1850 S A W GRIMES BLVD UNIT A-02
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7424
Mailing Address - Country:US
Mailing Address - Phone:512-675-0808
Mailing Address - Fax:512-640-6262
Practice Address - Street 1:1850 S A W GRIMES BLVD UNIT A-02
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7424
Practice Address - Country:US
Practice Address - Phone:512-675-0808
Practice Address - Fax:512-640-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty