Provider Demographics
NPI:1790102754
Name:PATEL, BIJAL (DMD)
Entity Type:Individual
Prefix:
First Name:BIJAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 N LOOP 1604 W
Mailing Address - Street 2:SUITE 118
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4628
Mailing Address - Country:US
Mailing Address - Phone:210-479-8779
Mailing Address - Fax:
Practice Address - Street 1:1207 N LOOP 1604 W
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4628
Practice Address - Country:US
Practice Address - Phone:210-479-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist