Healthcare Provider Details

I. General information

NPI: 1770198558
Provider Name (Legal Business Name): RAVINA PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E SPRING ST
MONROE GA
30655-2350
US

IV. Provider business mailing address

416 E SPRING ST
MONROE GA
30655-2350
US

V. Phone/Fax

Practice location:
  • Phone: 470-486-7975
  • Fax:
Mailing address:
  • Phone: 470-486-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN016134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: