Provider Demographics
NPI:1023365004
Name:PATEL, NIRAJ KUMAR (DDS)
Entity Type:Individual
Prefix:
First Name:NIRAJ
Middle Name:KUMAR
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 1:4470 GREEN VALLEY RD STE 161
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3064
Mailing Address - Country:US
Mailing Address - Phone:210-797-7740
Mailing Address - Fax:210-257-8440
Practice Address - Street 1:4470 GREEN VALLEY RD STE 161
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3064
Practice Address - Country:US
Practice Address - Phone:210-797-7740
Practice Address - Fax:210-257-8440
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice