Provider Demographics
NPI:1326175076
Name:PATEL, KUMAR JASHBHAI (DMD,MS)
Entity Type:Individual
Prefix:
First Name:KUMAR
Middle Name:JASHBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SHAW PARK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3847
Mailing Address - Country:US
Mailing Address - Phone:770-429-1545
Mailing Address - Fax:770-429-1896
Practice Address - Street 1:845 SHAW PARK RD
Practice Address - Street 2:SUITE A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3847
Practice Address - Country:US
Practice Address - Phone:770-429-1545
Practice Address - Fax:770-429-1896
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123171223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics