Provider Demographics
NPI:1689685307
Name:PATEL, NIYATI SNEHAL (DDS)
Entity Type:Individual
Prefix:
First Name:NIYATI
Middle Name:SNEHAL
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 1:550 WATER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-427-1660
Mailing Address - Fax:
Practice Address - Street 1:550 WATER ST STE 1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-427-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX275981223E0200X
CA47984122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942210447OtherTIN