Provider Demographics
NPI:1700865789
Name:PATEL, PARAJITA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:PARAJITA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:PARAJITA
Other - Middle Name:
Other - Last Name:GEHLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2849 ASHFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-842-0347
Mailing Address - Fax:
Practice Address - Street 1:1816 LAKEFIELD CT
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:770-860-8760
Practice Address - Fax:678-413-8144
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5519122300000X
CA58828122300000X
GADN012837122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA976722705BMedicaid