Healthcare Provider Details

I. General information

NPI: 1003555921
Provider Name (Legal Business Name): DARSHAN MAYUR PATEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 PAVILION PKWY
FAYETTEVILLE GA
30214-7732
US

IV. Provider business mailing address

905 CAROLINUS CT
MCDONOUGH GA
30253-8008
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-6975
  • Fax:
Mailing address:
  • Phone: 832-477-1298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN122757
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: