Provider Demographics
NPI:1538652417
Name:PATEL, DUSAYANT (DMD)
Entity Type:Individual
Prefix:
First Name:DUSAYANT
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 CARLISLE ST APT 228
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1147
Mailing Address - Country:US
Mailing Address - Phone:832-830-4599
Mailing Address - Fax:
Practice Address - Street 1:1111 W AIRPORT FWY # 201
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6203
Practice Address - Country:US
Practice Address - Phone:972-793-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist