Provider Demographics
NPI:1346795317
Name:BIRDI, JALPA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JALPA
Middle Name:
Last Name:BIRDI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JALPA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:11200 NE 11TH ST APT B210
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4562
Mailing Address - Country:US
Mailing Address - Phone:678-485-7077
Mailing Address - Fax:
Practice Address - Street 1:1867 JONESBORO RD STE 61867
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6099
Practice Address - Country:US
Practice Address - Phone:678-432-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60727737122300000X
GADN0151671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist