Provider Demographics
NPI:1205991809
Name:PATEL, NIMISHA V (DDS)
Entity type:Individual
Prefix:
First Name:NIMISHA
Middle Name:V
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 1:5805 SHANA PL
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3663
Mailing Address - Country:US
Mailing Address - Phone:703-533-1993
Mailing Address - Fax:
Practice Address - Street 1:105 N VIRGINIA AVE STE 103
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3323
Practice Address - Country:US
Practice Address - Phone:703-533-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist