Provider Demographics
NPI:1194736124
Name:PATEL, NIKHIL M (DMD)
Entity type:Individual
Prefix:
First Name:NIKHIL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LINCOLN ST
Mailing Address - Street 2:#2
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-756-5141
Mailing Address - Fax:
Practice Address - Street 1:130 LINCOLN ST
Practice Address - Street 2:#2
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-756-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0177211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0274526Medicaid
68871OtherDENTAL BENEFIT PROVIDERS
777108OtherTRICARE UNITED CONCORDIA
MAV04157OtherBLUE CROSS BLUE SHIELD