Provider Demographics
NPI:1912153362
Name:PATEL, NIRAJ RAVJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIRAJ
Middle Name:RAVJI
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 1:218 BURKEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4454
Mailing Address - Country:US
Mailing Address - Phone:828-437-7070
Mailing Address - Fax:
Practice Address - Street 1:218 BURKEMONT AVE
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4454
Practice Address - Country:US
Practice Address - Phone:828-437-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75491223G0001X
AZD75491223G0001X
NC9851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ611320Medicaid