Provider Demographics
NPI:1831644806
Name:PATEL, SHRADDHA G (DDS)
Entity Type:Individual
Prefix:MISS
First Name:SHRADDHA
Middle Name:G
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 1:5301 CHICAGO AVE
Mailing Address - Street 2:APT # 8202
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-2095
Mailing Address - Country:US
Mailing Address - Phone:732-983-8431
Mailing Address - Fax:
Practice Address - Street 1:1923 MARSHA SHARP FWY
Practice Address - Street 2:STE 103
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-4036
Practice Address - Country:US
Practice Address - Phone:806-744-6581
Practice Address - Fax:806-747-9794
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32324122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist