Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 32893 | TX |
NPI | 1184136343 |
---|---|
Provider Name | Megha Y Pathak |
First Address | Sugar Land, TX 77479-5200 |
Second Address | Sugar Land, TX 77479-5200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2017 |
Last Update Date | 17/03/2018 |