Provider Demographics
NPI:1154767481
Name:PATEL, MANTHAN HARSHADBHAI (DDS)
Entity type:Individual
Prefix:DR
First Name:MANTHAN
Middle Name:HARSHADBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 LAKE CAROLYN PKWY
Mailing Address - Street 2:APT 2314
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3928
Mailing Address - Country:US
Mailing Address - Phone:305-322-7539
Mailing Address - Fax:
Practice Address - Street 1:1930 E PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4744
Practice Address - Country:US
Practice Address - Phone:817-801-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist