Healthcare Provider Details

I. General information

NPI: 1104338748
Provider Name (Legal Business Name): NIMESH N PATEL DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CREEK RD STE B
IRVINE CA
92604-4791
US

IV. Provider business mailing address

33 CREEK RD STE B
IRVINE CA
92604-4791
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-6757
  • Fax: 949-857-0791
Mailing address:
  • Phone: 949-857-6757
  • Fax: 949-857-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number52911
License Number StateCA

VIII. Authorized Official

Name: NIMESH N PATEL
Title or Position: OWNER
Credential: DDS
Phone: 949-857-6757