Provider Demographics
NPI:1144478827
Name:PATEL, CHIRAG SURESH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHIRAG
Middle Name:SURESH
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 STONELAKE DR
Mailing Address - Street 2:APT. # 512
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-8790
Mailing Address - Country:US
Mailing Address - Phone:615-364-5569
Mailing Address - Fax:
Practice Address - Street 1:4701 BRYANT IRVIN ROAD
Practice Address - Street 2:VIOLA M. PITTS - COMO DENTAL
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107
Practice Address - Country:US
Practice Address - Phone:817-920-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice