Provider Demographics
NPI:1942549696
Name:PATEL, PURAV (DMD)
Entity Type:Individual
Prefix:DR
First Name:PURAV
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 1:811 E 11TH ST
Mailing Address - Street 2:APT 229
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1930
Mailing Address - Country:US
Mailing Address - Phone:732-318-8876
Mailing Address - Fax:
Practice Address - Street 1:2203 W 35TH ST
Practice Address - Street 2:BUILDING 727
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1203
Practice Address - Country:US
Practice Address - Phone:512-454-4731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297781223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice