Provider Demographics
NPI:1720574932
Name:PATEL, DIPESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIPESH
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 1:1071 LAKE CAROLYN PKWY APT 1048
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4853
Mailing Address - Country:US
Mailing Address - Phone:312-593-3007
Mailing Address - Fax:
Practice Address - Street 1:1425 N O CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4654
Practice Address - Country:US
Practice Address - Phone:312-593-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice