Provider Demographics
NPI:1073554630
Name:PATEL, PIYUSHKIMAR P (DDS)
Entity Type:Individual
Prefix:
First Name:PIYUSHKIMAR
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 MOUNT VERNON RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4103
Mailing Address - Country:US
Mailing Address - Phone:770-559-3648
Mailing Address - Fax:
Practice Address - Street 1:1505 MOUNT VERNON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4103
Practice Address - Country:US
Practice Address - Phone:770-559-3648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery