Provider Demographics
NPI:1447868070
Name:PATEL, NIKITA (DMD)
Entity type:Individual
Prefix:DR
First Name:NIKITA
Middle Name:
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 1:3912 ACAPULCO ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6512
Mailing Address - Country:US
Mailing Address - Phone:817-320-7493
Mailing Address - Fax:
Practice Address - Street 1:2240 MARKET PLACE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-8098
Practice Address - Country:US
Practice Address - Phone:972-534-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice