Provider Demographics
NPI:1508608787
Name:RICKY PATEL DMD LLC
Entity type:Organization
Organization Name:RICKY PATEL DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-854-6095
Mailing Address - Street 1:7955 MAGNOLIA SQ
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4025
Mailing Address - Country:US
Mailing Address - Phone:229-854-6095
Mailing Address - Fax:
Practice Address - Street 1:5041 DALLAS HWY
Practice Address - Street 2:BLDG 2 STE B (204)
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127
Practice Address - Country:US
Practice Address - Phone:770-499-8717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental