Basic Information
| Provider Information | |||||||||
| NPI: | 1831644806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHRADDHA | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 CHICAGO AVE | ||||||||
| Address2: | APT # 8202 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794142095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329838431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1923 MARSHA SHARP FWY | ||||||||
| Address2: | STE 103 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794154036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067446581 | ||||||||
| FaxNumber: | 8067479794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2016 | ||||||||
| LastUpdateDate: | 01/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 32324 | TX | N | Dental Providers | Dentist | 1223G0001X | 32324 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.