Healthcare Provider Details

I. General information

NPI: 1760524086
Provider Name (Legal Business Name): ULPA PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PONCE DE LEON AVE STE 300
DECATUR GA
30030-3469
US

IV. Provider business mailing address

8135 ROYAL SAINT GEORGES LN
DULUTH GA
30097-1650
US

V. Phone/Fax

Practice location:
  • Phone: 678-357-8762
  • Fax:
Mailing address:
  • Phone: 167-835-7876
  • Fax: 770-441-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number012422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: