Provider Demographics
NPI:1134448301
Name:PATEL, LEIGH ANN (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12420 CUMMING HWY
Mailing Address - Street 2:STE 306
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-7568
Mailing Address - Country:US
Mailing Address - Phone:678-947-3600
Mailing Address - Fax:
Practice Address - Street 1:12420 CUMMING HWY
Practice Address - Street 2:STE 306
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-7568
Practice Address - Country:US
Practice Address - Phone:678-947-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA465659589BMedicaid