Provider Demographics
NPI:1093060899
Name:PATEL, NIDHI A (DMD)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:NIDHI
Other - Middle Name:R
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4875 S QUIET WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0647
Mailing Address - Country:US
Mailing Address - Phone:480-628-9362
Mailing Address - Fax:
Practice Address - Street 1:1775 E FLORENCE BLVD STE 104
Practice Address - Street 2:STE 104
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4839
Practice Address - Country:US
Practice Address - Phone:520-413-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist