Provider Demographics
NPI:1477048155
Name:PATEL, DIMPLE JAYANTILAL (DMD)
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:JAYANTILAL
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 1:149 CARLISLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-6601
Mailing Address - Country:US
Mailing Address - Phone:407-937-9379
Mailing Address - Fax:
Practice Address - Street 1:276 POOLER PKWY STE A
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-5163
Practice Address - Country:US
Practice Address - Phone:912-480-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPENDING1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice