Provider Demographics
NPI:1770992935
Name:PATEL, NIPA K (DMD)
Entity type:Individual
Prefix:
First Name:NIPA
Middle Name:K
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:202
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-2564
Mailing Address - Country:US
Mailing Address - Phone:602-579-4060
Mailing Address - Fax:
Practice Address - Street 1:12770 MERIT DR
Practice Address - Street 2:#850
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1209
Practice Address - Country:US
Practice Address - Phone:972-361-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008901122300000X
TX316341223X0400X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics