Provider Demographics
NPI:1760899066
Name:RANA, DHAVALKUMAR
Entity Type:Individual
Prefix:
First Name:DHAVALKUMAR
Middle Name:
Last Name:RANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 OLD ELKHART RD.
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 EXCHANGE ST
Practice Address - Street 2:SUITE D
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4588
Practice Address - Country:US
Practice Address - Phone:817-426-9337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice