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General NPI Number Information
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NPI Number | 1073175691
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Entity Type | Organization
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Legal Business Name | ROAM DENTAL APPLIANCES LLC
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 01/17/2022
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Provider Practice Location Address
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Address Line | 4536 NELSON BROGDON BLVD BLDG A
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City | BUFORD
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State | GA
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Zip | 30518-7516
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Country | US
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Telephone | 470-412-5455
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Fax |
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Provider Business Mailing Address
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Address Line | 4536 NELSON BROGDON BLVD BLDG A
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City | BUFORD
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State | GA
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Zip | 30518-7516
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Country | US
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Telephone | 470-412-5455
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAVI A PATEL
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Credential | DMD
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Telephone | 317-364-3740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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