Healthcare Provider Details

I. General information

NPI: 1073554630
Provider Name (Legal Business Name): PIYUSHKIMAR P PATEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 SHERWOOD PARK DR NE STE C
GAINESVILLE GA
30501-3404
US

IV. Provider business mailing address

1505 MOUNT VERNON RD SUITE 150
DUNWOODY GA
30338-4103
US

V. Phone/Fax

Practice location:
  • Phone: 470-284-4695
  • Fax: 770-536-2815
Mailing address:
  • Phone: 770-559-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN011772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: