Provider Demographics
NPI:1104540665
Name:PATEL, DHRUVI PRAVINCHANDRA
Entity type:Individual
Prefix:
First Name:DHRUVI
Middle Name:PRAVINCHANDRA
Last Name: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 1:12357 DESERT DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2291
Mailing Address - Country:US
Mailing Address - Phone:310-307-9129
Mailing Address - Fax:
Practice Address - Street 1:9398 VISCOUNT BLVD STE 4B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-8028
Practice Address - Country:US
Practice Address - Phone:915-595-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY6335059OtherDRIVERS LICENSE