Provider Demographics
NPI:1497820963
Name:PATEL, MAYOOR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MAYOOR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ASHFORD CTR N
Mailing Address - Street 2:SUITE 195
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2668
Mailing Address - Country:US
Mailing Address - Phone:678-889-6076
Mailing Address - Fax:678-899-6075
Practice Address - Street 1:200 ASHFORD CTR N
Practice Address - Street 2:SUITE 195
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4157
Practice Address - Country:US
Practice Address - Phone:678-889-6076
Practice Address - Fax:678-899-6075
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist