Provider Demographics
NPI:1073175691
Name:ROAM DENTAL APPLIANCES LLC
Entity Type:Organization
Organization Name:ROAM DENTAL APPLIANCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-364-3740
Mailing Address - Street 1:4536 NELSON BROGDON BLVD BLDG A
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7516
Mailing Address - Country:US
Mailing Address - Phone:470-412-5455
Mailing Address - Fax:
Practice Address - Street 1:4536 NELSON BROGDON BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-7516
Practice Address - Country:US
Practice Address - Phone:470-412-5455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No122300000XDental ProvidersDentistGroup - Single Specialty