Provider Demographics
NPI:1467885194
Name:PATEL, DIMPLE
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 BOWSER AVE
Mailing Address - Street 2:APT 209
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2104
Mailing Address - Country:US
Mailing Address - Phone:713-825-1082
Mailing Address - Fax:
Practice Address - Street 1:11700 PRESTON RD
Practice Address - Street 2:STE 703
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6112
Practice Address - Country:US
Practice Address - Phone:214-750-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist