Provider Demographics
NPI:1659002632
Name:PATEL, PRIYA MILEN (DMD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:MILEN
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 1:190 SAGE RUN TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8050
Mailing Address - Country:US
Mailing Address - Phone:678-951-2735
Mailing Address - Fax:
Practice Address - Street 1:4536 NELSON BROGDON BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-7516
Practice Address - Country:US
Practice Address - Phone:678-853-7237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice