Provider Demographics
NPI:1093149874
Name:PATEL, JANKI DESAI (DMD)
Entity Type:Individual
Prefix:
First Name:JANKI
Middle Name:DESAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JANKI
Other - Middle Name:KAUSHAL
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31028-0284
Mailing Address - Country:US
Mailing Address - Phone:404-451-5321
Mailing Address - Fax:
Practice Address - Street 1:618 N HOUSTON LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31028-1010
Practice Address - Country:US
Practice Address - Phone:404-451-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist