Provider Demographics
NPI:1649530072
Name:PATEL, DIPESH V (DMD)
Entity type:Individual
Prefix:DR
First Name:DIPESH
Middle Name:V
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 DUNWOODY PARK
Mailing Address - Street 2:UNIT 1110
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5795
Mailing Address - Country:US
Mailing Address - Phone:706-409-2088
Mailing Address - Fax:
Practice Address - Street 1:2551 ROSWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4761
Practice Address - Country:US
Practice Address - Phone:770-514-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003132094AMedicaid