Provider Demographics
NPI:1770808172
Name:NIRAV R. PATEL, DDS, PLLC
Entity type:Organization
Organization Name:NIRAV R. PATEL, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:RAJENDRA
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-869-2273
Mailing Address - Street 1:7423 LAS COLINAS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7579
Mailing Address - Country:US
Mailing Address - Phone:972-869-2273
Mailing Address - Fax:
Practice Address - Street 1:7423 LAS COLINAS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7579
Practice Address - Country:US
Practice Address - Phone:972-869-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1744336-02Medicaid