Provider Demographics
NPI:1568518082
Name:PATYAL, MEENA
Entity Type:Individual
Prefix:
First Name:MEENA
Middle Name:
Last Name:PATYAL
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 1:11130 JOLLYVILLE RD.
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759
Mailing Address - Country:US
Mailing Address - Phone:408-398-0487
Mailing Address - Fax:
Practice Address - Street 1:11130 JOLLYVILLE RD.
Practice Address - Street 2:SUITE 1500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:408-398-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice