Healthcare Provider Details

I. General information

NPI: 1427897214
Provider Name (Legal Business Name): ALISHA NAYMISH PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 OLD WINDER HWY STE 100
BRASELTON GA
30517-6102
US

IV. Provider business mailing address

708 BLUFF RD
STATHAM GA
30666-2537
US

V. Phone/Fax

Practice location:
  • Phone: 770-965-2340
  • Fax:
Mailing address:
  • Phone: 706-765-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN124218
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: