Provider Demographics
NPI:1851607055
Name:PATEL, VISHAL (DMD)
Entity Type:Individual
Prefix:
First Name:VISHAL
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 1:15630 QUORUM DR
Mailing Address - Street 2:APT. #2523
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3350
Mailing Address - Country:US
Mailing Address - Phone:770-855-5696
Mailing Address - Fax:
Practice Address - Street 1:1720 N CENTRAL EXPY STE 130
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3100
Practice Address - Country:US
Practice Address - Phone:972-439-3794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice