Provider Demographics
NPI:1285642017
Name:RALPH, PATRICK M (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:M
Last Name:RALPH
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 1:11921 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1425
Mailing Address - Country:US
Mailing Address - Phone:281-495-3343
Mailing Address - Fax:281-495-1125
Practice Address - Street 1:11921 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1425
Practice Address - Country:US
Practice Address - Phone:281-495-3343
Practice Address - Fax:281-495-1125
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169367301Medicaid