Provider Demographics
NPI:1417085242
Name:KINNARI PRAJAPATI, D.D.S., PA
Entity Type:Organization
Organization Name:KINNARI PRAJAPATI, D.D.S., PA
Other - Org Name:CANYON CREEK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KINNARI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAJAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:254-771-5900
Mailing Address - Street 1:7718 BUCKMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3708
Mailing Address - Country:US
Mailing Address - Phone:512-869-8300
Mailing Address - Fax:512-869-8300
Practice Address - Street 1:1618 CANYON CREEK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3275
Practice Address - Country:US
Practice Address - Phone:254-771-5900
Practice Address - Fax:254-771-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01361994OtherUC
TXB20617OtherBCBS