Provider Demographics
NPI:1336797638
Name:I&A DENTAL PLLC
Entity Type:Organization
Organization Name:I&A DENTAL PLLC
Other - Org Name:PALM TREE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:551-208-7289
Mailing Address - Street 1:1548 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2814
Mailing Address - Country:US
Mailing Address - Phone:361-777-0700
Mailing Address - Fax:
Practice Address - Street 1:2334 STATE HIGHWAY 361 STE 162
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-4143
Practice Address - Country:US
Practice Address - Phone:361-777-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I&A DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental