Provider Demographics
NPI:1417181199
Name:ACCESS ORTHODONTICS OF MEADOWBROOK
Entity Type:Organization
Organization Name:ACCESS ORTHODONTICS OF MEADOWBROOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTICS
Authorized Official - Prefix:
Authorized Official - First Name:ANURAG
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-446-0800
Mailing Address - Street 1:6302 MEADOWBROOK DR
Mailing Address - Street 2:SUITE #112
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-5121
Mailing Address - Country:US
Mailing Address - Phone:817-446-0800
Mailing Address - Fax:817-446-0802
Practice Address - Street 1:6302 MEADOWBROOK DR
Practice Address - Street 2:SUITE #112
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-5121
Practice Address - Country:US
Practice Address - Phone:817-446-0800
Practice Address - Fax:817-446-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty