Healthcare Provider Details

I. General information

NPI: 1336091362
Provider Name (Legal Business Name): NIKITA HARSHADKUMAR PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 KITTY HAWK RD STE 102
CONVERSE TX
78109-1766
US

IV. Provider business mailing address

7875 KITTY HAWK RD STE 102
CONVERSE TX
78109-1766
US

V. Phone/Fax

Practice location:
  • Phone: 210-898-8845
  • Fax:
Mailing address:
  • Phone: 210-898-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: