Provider Demographics
NPI:1063256535
Name:RADADIYA AKA PATEL, HIMANI
Entity type:Individual
Prefix:
First Name:HIMANI
Middle Name:
Last Name:RADADIYA AKA PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 DIANNA DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9499
Mailing Address - Country:US
Mailing Address - Phone:405-673-9868
Mailing Address - Fax:
Practice Address - Street 1:260 DIANNA DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9499
Practice Address - Country:US
Practice Address - Phone:405-673-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist