Provider Demographics
NPI:1841551264
Name:POPAT, NITESH (DDS)
Entity type:Individual
Prefix:DR
First Name:NITESH
Middle Name:
Last Name:POPAT
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 1:3315 RANCH ROAD 620 S STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6873
Mailing Address - Country:US
Mailing Address - Phone:512-402-9090
Mailing Address - Fax:
Practice Address - Street 1:3315 RANCH ROAD 620 S STE 250
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-6873
Practice Address - Country:US
Practice Address - Phone:512-402-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014141701223G0001X
MI2901020709122300000X
TX32639122300000X
CA100990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice