Provider Demographics
NPI:1518527316
Name:KETAN P. PAREKH DDS, PA
Entity Type:Organization
Organization Name:KETAN P. PAREKH DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAREKH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-338-2397
Mailing Address - Street 1:3147 BOURBON STREET CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3018 RIDGE RD STE 120
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5819
Practice Address - Country:US
Practice Address - Phone:469-338-2397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty