Provider Demographics
NPI:1033788096
Name:PATEL, MILEN RAJESH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILEN
Middle Name:RAJESH
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 1:129 POST HOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9624
Mailing Address - Country:US
Mailing Address - Phone:912-695-2830
Mailing Address - Fax:
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4508
Practice Address - Country:US
Practice Address - Phone:912-748-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.9965122300000X
GADN1223801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist