MEDICARE: NIMISHA V PATEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401410290	VA

General Provider Information

NPI Number	:	1205991809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMISHA V PATEL DDS

Provider Business Mailing Address
First Line	:	5805 SHANA PL
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-3663
Country	:	US
Telephone Number	:	703-533-1993
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 N VIRGINIA AVE STE 103
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3323
Country	:	US
Telephone Number	:	703-533-1993
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2006
Last Update Date	:	07/08/2007

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