Provider Demographics
NPI:1669364360
Name:PABALKAR, PREETAM VILAS
Entity type:Individual
Prefix:
First Name:PREETAM
Middle Name:VILAS
Last Name:PABALKAR
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 1:6301 STONEWOOD DR APT 1621
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5274
Mailing Address - Country:US
Mailing Address - Phone:424-206-0245
Mailing Address - Fax:
Practice Address - Street 1:8030 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-3827
Practice Address - Country:US
Practice Address - Phone:972-716-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice