Provider Demographics
NPI:1457560377
Name:PATEL, SIMMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIMMI
Middle Name:
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 1:900 CAMINO LAGO
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3047
Mailing Address - Country:US
Mailing Address - Phone:281-744-2677
Mailing Address - Fax:
Practice Address - Street 1:5015 TRACY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3452
Practice Address - Country:US
Practice Address - Phone:214-522-3366
Practice Address - Fax:214-522-3387
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice