Provider Demographics
NPI:1871282525
Name:PATEL, RAJIV (DMD)
Entity type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 KATIE HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578
Mailing Address - Country:US
Mailing Address - Phone:832-622-8808
Mailing Address - Fax:
Practice Address - Street 1:1403 N LOOP 336 W STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3672
Practice Address - Country:US
Practice Address - Phone:281-602-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist