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General NPI Number Information
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NPI Number | 1649602681
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Entity Type | Individual
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Provider Name | NIRAV BHARATBHAI PATEL DMD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 217 SOUTH ST
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City | HOLYOKE
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State | MA
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Zip | 01040-3611
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Country | US
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Telephone | 413-315-4527
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Fax |
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Provider Business Mailing Address
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Address Line | 360 N ARROYO GRANDE BLVD APT 113
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City | HENDERSON
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State | NV
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Zip | 89014-3965
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02544200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS039702
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 12160
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN1857875
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License Number State | MA
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