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General NPI Number Information
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NPI Number | 1225478415
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Entity Type | Individual
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Provider Name | NISHA SANJAY PATEL DMD
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Gender | Female
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 6837 NORMANDY DR BLDG B
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone | 910-396-1444
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Fax |
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Provider Business Mailing Address
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Address Line | BLDG 38717, 38TH STREET
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City | FORT GORDON
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State | GA
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Zip | 30905
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Country | US
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Telephone | 706-787-6927
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS039632
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 13043
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License Number State | NC
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