Provider Demographics
NPI:1386156131
Name:NIMESH PATEL A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:NIMESH PATEL A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-459-2866
Mailing Address - Street 1:30012 CROWN VALLEY PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1700
Mailing Address - Country:US
Mailing Address - Phone:949-495-2866
Mailing Address - Fax:949-495-2868
Practice Address - Street 1:30012 CROWN VALLEY PKWY STE B
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1700
Practice Address - Country:US
Practice Address - Phone:949-495-2866
Practice Address - Fax:949-495-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty