Provider Demographics
NPI:1568942878
Name:PATANKAR, NIKEETA
Entity Type:Individual
Prefix:
First Name:NIKEETA
Middle Name:
Last Name:PATANKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 MARBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8325
Mailing Address - Country:US
Mailing Address - Phone:571-298-2000
Mailing Address - Fax:
Practice Address - Street 1:12701 MARBLESTONE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8325
Practice Address - Country:US
Practice Address - Phone:571-298-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014162761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics