Provider Demographics
NPI:1871800979
Name:PATEL, DIPTI V (DMD)
Entity type:Individual
Prefix:DR
First Name:DIPTI
Middle Name:V
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1678 MULKEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1147
Mailing Address - Country:US
Mailing Address - Phone:770-343-4476
Mailing Address - Fax:
Practice Address - Street 1:1678 MULKEY RD STE D
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1147
Practice Address - Country:US
Practice Address - Phone:770-343-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5797C11223G0001X
NC93401223G0001X
GADN0105781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice