Healthcare Provider Details

I. General information

NPI: 1922678119
Provider Name (Legal Business Name): BRIANNA ATUL PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 PEACH ORCHARD RD
AUGUSTA GA
30906-3505
US

IV. Provider business mailing address

5214 GOLDEN EAGLE TER
DAVIE FL
33314-3904
US

V. Phone/Fax

Practice location:
  • Phone: 706-798-6720
  • Fax:
Mailing address:
  • Phone: 561-704-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122337
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: