Provider Demographics
NPI:1316037468
Name:PATEL, NIRAV A (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:A
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 1:11841 PALM BEACH BLVD
Mailing Address - Street 2:UNIT #115
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5913
Mailing Address - Country:US
Mailing Address - Phone:239-694-7702
Mailing Address - Fax:239-694-7260
Practice Address - Street 1:11841 PALM BEACH BLVD
Practice Address - Street 2:UNIT #115
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5913
Practice Address - Country:US
Practice Address - Phone:239-694-7702
Practice Address - Fax:239-694-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist