Provider Demographics
NPI:1851549562
Name:PATEL, RUCHIR R
Entity Type:Individual
Prefix:
First Name:RUCHIR
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RUCHIR
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:625 W CROSSVILLE RD
Mailing Address - Street 2:ICLEAR ORTHODONTICS SUITE 120
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7503
Mailing Address - Country:US
Mailing Address - Phone:404-902-5327
Mailing Address - Fax:
Practice Address - Street 1:625 W CROSSVILLE RD
Practice Address - Street 2:ICLEAR ORTHODONTICS SUITE 120
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7503
Practice Address - Country:US
Practice Address - Phone:404-902-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60398450122300000X
GADN0145421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist