MEDICARE: NIDHI PATEL DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	28499	FL

General Provider Information

NPI Number	:	1407547045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIDHI PATEL DMD

Provider Business Mailing Address
First Line	:	22607 MORNING GLORY CIR
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-6357
Country	:	US
Telephone Number	:	941-323-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	13246 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2408
Country	:	US
Telephone Number	:	813-797-5940
Fax Number	:

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

Provider Enumeration Date	:	05/16/2023
Last Update Date	:	08/06/2025

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