Provider Demographics
NPI:1699954552
Name:PATEL, RAJIV (ENDODONTIST)
Entity type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:ENDODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 BLANCO DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7328
Mailing Address - Country:US
Mailing Address - Phone:940-725-3655
Mailing Address - Fax:
Practice Address - Street 1:503 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MUENSTER
Practice Address - State:TX
Practice Address - Zip Code:76252-2425
Practice Address - Country:US
Practice Address - Phone:940-759-2303
Practice Address - Fax:940-759-2399
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics