Healthcare Provider Details

I. General information

NPI: 1497365498
Provider Name (Legal Business Name): KRINA PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PROFESSIONAL CT SW
ROME GA
30165-2844
US

IV. Provider business mailing address

21 PROFESSIONAL CT SW
ROME GA
30165-2844
US

V. Phone/Fax

Practice location:
  • Phone: 706-232-1923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD.0006810-C1
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4433-24
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number123968
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: