Provider Demographics
NPI:1417333980
Name:PATEL, YESHA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:YESHA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10424 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2478
Mailing Address - Country:US
Mailing Address - Phone:770-841-9640
Mailing Address - Fax:
Practice Address - Street 1:1275 POWERS FERRY RD SE
Practice Address - Street 2:#10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9486
Practice Address - Country:US
Practice Address - Phone:678-831-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist