Provider Demographics
NPI:1164530663
Name:DR NIMISH PATEL PC
Entity Type:Organization
Organization Name:DR NIMISH PATEL PC
Other - Org Name:RIVERDALE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIMISH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-997-6222
Mailing Address - Street 1:6650 HWY 85
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-997-6222
Mailing Address - Fax:
Practice Address - Street 1:6650 HWY 85
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-997-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty