Provider Demographics
NPI:1639283229
Name:PATEL, MITUL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITUL
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2627 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1018
Mailing Address - Country:US
Mailing Address - Phone:770-888-3384
Mailing Address - Fax:770-888-3081
Practice Address - Street 1:2627 PEACHTREE PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1018
Practice Address - Country:US
Practice Address - Phone:770-888-3384
Practice Address - Fax:770-888-3081
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice