Healthcare Provider Details

I. General information

NPI: 1841551264
Provider Name (Legal Business Name): NITESH POPAT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 TUSCAN WAY STE 306
ST AUGUSTINE FL
32092-1849
US

IV. Provider business mailing address

46 TUSCAN WAY STE 306
ST AUGUSTINE FL
32092-1849
US

V. Phone/Fax

Practice location:
  • Phone: 904-395-7822
  • Fax:
Mailing address:
  • Phone: 904-395-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32639
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401414170
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901020709
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number100990
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: