Provider Demographics
NPI:1033261284
Name:PATEL, NIRAV NANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:NANA
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 1:2361 S CUTTY WAY
Mailing Address - Street 2:UNIT #64
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3560
Mailing Address - Country:US
Mailing Address - Phone:714-603-4432
Mailing Address - Fax:
Practice Address - Street 1:200 S WELLS RD # 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1377
Practice Address - Country:US
Practice Address - Phone:714-603-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice