Healthcare Provider Details

I. General information

NPI: 1124636618
Provider Name (Legal Business Name): PRIYANKA J PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4745 NELSON BROGDON BLVD STE 100
BUFORD GA
30518-3714
US

IV. Provider business mailing address

4745 NELSON BROGDON BLVD STE 100
BUFORD GA
30518-3714
US

V. Phone/Fax

Practice location:
  • Phone: 770-271-4411
  • Fax: 770-271-4499
Mailing address:
  • Phone: 770-271-4411
  • Fax: 770-271-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124026
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: