1144478827 NPI number — DR. CHIRAG SURESH PATEL D.D.S.

Table of content: DR. CHIRAG SURESH PATEL D.D.S. (NPI 1144478827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144478827 NPI number — DR. CHIRAG SURESH PATEL D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
CHIRAG
Provider Middle Name:
SURESH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144478827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 STONELAKE DR
Provider Second Line Business Mailing Address:
APT. # 512
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75050-8790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-364-5569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 BRYANT IRVIN ROAD
Provider Second Line Business Practice Location Address:
VIOLA M. PITTS - COMO DENTAL
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-920-7415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  24211 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)