Provider Demographics
NPI:1164539342
Name:PATEL, NIMESH L (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIMESH
Middle Name:L
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2041
Mailing Address - Country:US
Mailing Address - Phone:860-633-6246
Mailing Address - Fax:860-633-1808
Practice Address - Street 1:2450 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2041
Practice Address - Country:US
Practice Address - Phone:860-633-6246
Practice Address - Fax:860-633-1808
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice