Provider Demographics
NPI:1659724326
Name:PATEL, SUPRIYA GIRISHKUMAR (DDS)
Entity Type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:GIRISHKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N VISTA RIDGE BLVD
Mailing Address - Street 2:SUITE #700
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7637
Mailing Address - Country:US
Mailing Address - Phone:512-402-7811
Mailing Address - Fax:512-777-4076
Practice Address - Street 1:920 N VISTA RIDGE BLVD
Practice Address - Street 2:SUITE #700
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7637
Practice Address - Country:US
Practice Address - Phone:512-402-7811
Practice Address - Fax:512-777-4076
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist