Provider Demographics
NPI:1841021524
Name:PATEL, ROMA JAYMIN
Entity type:Individual
Prefix:
First Name:ROMA
Middle Name:JAYMIN
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ABBOTT CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1402
Mailing Address - Country:US
Mailing Address - Phone:630-776-3640
Mailing Address - Fax:
Practice Address - Street 1:135 CEDAR ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3745
Practice Address - Country:US
Practice Address - Phone:912-715-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist