Shivam Patel, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

40315 Issued in TX

Practice address

11831 Culebra Rd Ste 101
San Antonio, TX 78253-4578

Phone

(210) 625-5353

NPI assigned

Feb 23, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Potranco Children's Dental Association

  dba Imagine Children's Dentistry and Orthodontics

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1952066458
  NPD (past)
• Purple Iris Dental Association

  • Pediatric Dentistry
  • San Antonio, TX
  • NPI 1558849893
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1225784705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11831 CULEBRA RD STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782534578",
            "telephone_number": "210-625-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11831 CULEBRA RD STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782534578",
            "telephone_number": "210-625-5353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18010 Bulverde Rd Ste 112",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782593346",
            "country_code": "US",
            "telephone_number": "210-729-0900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12991 Potranco Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782537105",
            "country_code": "US",
            "telephone_number": "210-529-7995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SHIVAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-23",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "40315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011976",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Setu Dipak Patel
• Shaily D Patel, COTA
• Sheil S. Patel, D.O.
• Shila Patel
• Shiv Patel, IOM
• Shivam Patel, IONM
• Shivani K Patel
• Shivani K. Patel, OD
• Shivani Manish Patel, DO
• Shreena Patel, FNP

• Pediatric Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.