Provider Demographics
NPI:1548571409
Name:PATEL, VIMAL A (DDS)
Entity Type:Individual
Prefix:
First Name:VIMAL
Middle Name:A
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N. COLEMAN ST.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:821 N. COLEMAN ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078
Practice Address - Country:US
Practice Address - Phone:972-347-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27680122300000X
NE6906122300000X
MO2011011989122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist