Provider Demographics
NPI:1174831127
Name:PATEL, NIRAV M (DMD)
Entity type:Individual
Prefix:DR
First Name:NIRAV
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 STATE ROUTE 31 S
Mailing Address - Street 2:SUTIE 6
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-4086
Mailing Address - Country:US
Mailing Address - Phone:908-689-5129
Mailing Address - Fax:
Practice Address - Street 1:269 STATE ROUTE 31 S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4086
Practice Address - Country:US
Practice Address - Phone:908-689-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024519001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice