Provider Demographics
NPI:1982221883
Name:PATEL, NATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 PICARDY AVE APT 1407
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3776
Mailing Address - Country:US
Mailing Address - Phone:501-940-1998
Mailing Address - Fax:
Practice Address - Street 1:8670 AIRLINE HWY STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-8128
Practice Address - Country:US
Practice Address - Phone:225-927-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist