Healthcare Provider Details

I. General information

NPI: 1154175909
Provider Name (Legal Business Name): RUCHI PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N DREAMY DRAW DR STE 4
PHOENIX AZ
85020-5278
US

IV. Provider business mailing address

113 FOUNTAIN OAK
VILLA RICA GA
30180-6994
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1245
  • Fax:
Mailing address:
  • Phone: 678-993-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61545440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: