Provider Demographics
NPI:1649581091
Name:PATEL, NISHITH
Entity Type:Individual
Prefix:
First Name:NISHITH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 50TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3845
Mailing Address - Country:US
Mailing Address - Phone:941-792-7777
Mailing Address - Fax:941-792-8400
Practice Address - Street 1:507 50TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3845
Practice Address - Country:US
Practice Address - Phone:941-792-7777
Practice Address - Fax:941-792-8400
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist