Provider Demographics
NPI:1376055830
Name:PATKI, MITHILA PRAMOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITHILA
Middle Name:PRAMOD
Last Name:PATKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11604 SEWICKLEY CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5079
Mailing Address - Country:US
Mailing Address - Phone:323-327-6614
Mailing Address - Fax:
Practice Address - Street 1:11604 SEWICKLEY CT
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5079
Practice Address - Country:US
Practice Address - Phone:323-327-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice