Provider Demographics
NPI:1366928913
Name:PATEL, VISHWAM PINAKIN
Entity type:Individual
Prefix:
First Name:VISHWAM
Middle Name:PINAKIN
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 PLEASANT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-2006
Mailing Address - Country:US
Mailing Address - Phone:972-363-7331
Mailing Address - Fax:
Practice Address - Street 1:661 E MAIN ST STE 800
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3342
Practice Address - Country:US
Practice Address - Phone:682-773-3072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice