Healthcare Provider Details

I. General information

NPI: 1942992862
Provider Name (Legal Business Name): AVNI DEVENDRA PATEL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W BANKHEAD HWY
VILLA RICA GA
30180-1702
US

IV. Provider business mailing address

1235 MANDEVILLE RD
CARROLLTON GA
30117-5439
US

V. Phone/Fax

Practice location:
  • Phone: 770-456-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123863
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: