Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019.032282 | IL |
N | 122300000X | Dentist | 37070 | TX |
N | 1223P0700X | Prosthodontist | 37070 | TX |
NPI | 1144877689 |
---|---|
Provider Name | Dr. Nisha Patel |
First Address | Schaumburg, IL 60193-1833 |
Second Address | Park Ridge, IL 60068-5761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2019 |
Last Update Date | 29/08/2021 |