Provider Demographics
NPI:1417970591
Name:PATEL, NISHA MAYUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:MAYUR
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S LAKE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-2436
Mailing Address - Country:US
Mailing Address - Phone:818-843-6411
Mailing Address - Fax:818-843-6416
Practice Address - Street 1:905 S LAKE ST STE 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2436
Practice Address - Country:US
Practice Address - Phone:818-843-6411
Practice Address - Fax:818-843-6416
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice