Provider Demographics
NPI:1427190743
Name:PATEL, PRAVINA (DMD)
Entity type:Individual
Prefix:
First Name:PRAVINA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 HILLCROFT ST
Mailing Address - Street 2:STE D6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036
Mailing Address - Country:US
Mailing Address - Phone:713-781-1170
Mailing Address - Fax:713-781-6659
Practice Address - Street 1:5901 HILLCROFT ST
Practice Address - Street 2:STE D6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:713-781-1170
Practice Address - Fax:713-781-6659
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20764122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01407989OtherUNITED CONCORDIA
TXB2076401OtherDELTA DENTAL CHIP