Provider Demographics
NPI:1780042010
Name:PATEL, NIRAV VISHNUPRASAD (BDS, MPH, MDS, DDS)
Entity Type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:VISHNUPRASAD
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS, MPH, MDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 BAYCREST DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7675
Mailing Address - Country:US
Mailing Address - Phone:347-567-5081
Mailing Address - Fax:
Practice Address - Street 1:13515 LAKE TERRACE LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-1003
Practice Address - Country:US
Practice Address - Phone:813-972-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022100122300000X
IL190305471223G0001X
TX316351223G0001X
NJ22DI027840001223P0700X
NY0608481223P0700X
FLDN256271223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice