Healthcare Provider Details

I. General information

NPI: 1205219672
Provider Name (Legal Business Name): PERIMETER FACIAL SURGEONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MOUNT VERNON RD # 150
DUNWOODY GA
30338-4157
US

IV. Provider business mailing address

1505 MOUNT VERNON RD # 150
DUNWOODY GA
30338-4157
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-3648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number11772
License Number StateGA

VIII. Authorized Official

Name: DR. PIYUSH PATEL
Title or Position: OMFS
Credential:
Phone: 770-559-3648