Provider Demographics
NPI:1518270891
Name:PATHAK, AMEE (DMD)
Entity Type:Individual
Prefix:
First Name:AMEE
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAKE CAROLYN PKWY APT 452
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4814
Mailing Address - Country:US
Mailing Address - Phone:213-344-8609
Mailing Address - Fax:
Practice Address - Street 1:2604 OLD DENTON RD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5109
Practice Address - Country:US
Practice Address - Phone:213-344-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25967122300000X
MO2010020531111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2010020531Medicaid
MO2010020531OtherPEDIACTRICS