Provider Demographics
NPI:1144297953
Name:PATEL, ANURAG RAMESH (DMD, MSED)
Entity type:Individual
Prefix:DR
First Name:ANURAG
Middle Name:RAMESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 HERITAGE TRACE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5308
Mailing Address - Country:US
Mailing Address - Phone:817-431-0707
Mailing Address - Fax:
Practice Address - Street 1:4120 HERITAGE TRACE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5308
Practice Address - Country:US
Practice Address - Phone:817-431-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190255191223X0400X
TX232181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics