Healthcare Provider Details

I. General information

NPI: 1538805874
Provider Name (Legal Business Name): PARIN JAYESH PATEL D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHEROKEE PL
CARTERSVILLE GA
30121-2967
US

IV. Provider business mailing address

2677 ALMSHOUSE LN NE
ATLANTA GA
30329-4709
US

V. Phone/Fax

Practice location:
  • Phone: 770-387-1618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122680
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: