Provider Demographics
NPI:1760135297
Name:PATEL, MEERA ROOPESH (DDS)
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:ROOPESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 HICKORY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2680
Mailing Address - Country:US
Mailing Address - Phone:812-455-8361
Mailing Address - Fax:
Practice Address - Street 1:6759 HICKORY RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2019
Practice Address - Country:US
Practice Address - Phone:678-540-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1226921223G0001X
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program