Provider Demographics
NPI:1760265441
Name:PARAB, EKTA EKANATH (DMD)
Entity Type:Individual
Prefix:
First Name:EKTA
Middle Name:EKANATH
Last Name:PARAB
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 1:912 KILLIAN HILL ROAD SOUTHWEST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047
Mailing Address - Country:US
Mailing Address - Phone:770-923-3966
Mailing Address - Fax:770-564-8617
Practice Address - Street 1:912 KILLIAN HILL ROAD SOUTHWEST
Practice Address - Street 2:SUITE 100
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047
Practice Address - Country:US
Practice Address - Phone:770-923-3966
Practice Address - Fax:770-564-8617
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1231031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice