Provider Demographics
NPI:1134016140
Name:PATIL, NIKITA
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 FOSTERBURG RD APT 5
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-7368
Mailing Address - Country:US
Mailing Address - Phone:614-620-0249
Mailing Address - Fax:614-620-0249
Practice Address - Street 1:3271 FOSTERBURG RD APT 5
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7368
Practice Address - Country:US
Practice Address - Phone:614-620-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0000001223G0001X
OH00000001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice