Provider Demographics
NPI:1699400465
Name:DHRUVKUMAR PATEL DDS PLLC
Entity Type:Organization
Organization Name:DHRUVKUMAR PATEL DDS PLLC
Other - Org Name:DIVINE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DHRUVKUMAR
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-404-5978
Mailing Address - Street 1:3316 CANYON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2791
Mailing Address - Country:US
Mailing Address - Phone:714-404-5978
Mailing Address - Fax:
Practice Address - Street 1:966 N GARDEN RIDGE BLVD STE 510
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2876
Practice Address - Country:US
Practice Address - Phone:469-240-5590
Practice Address - Fax:469-240-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty