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General NPI Number Information
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NPI Number | 1316273659
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Entity Type | Individual
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Provider Name | MITALI Y PATEL DDS
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Gender | Female
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 12/04/2022
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Provider Practice Location Address
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Address Line | 1213 DALON RD NE STE 102
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City | ATLANTA
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State | GA
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Zip | 30306-2024
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Country | US
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Telephone | 404-418-6684
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Fax |
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Provider Business Mailing Address
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Address Line | 3527 AMBASSADOR ALY
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City | SCOTTDALE
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State | GA
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Zip | 30079-5609
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019.028075
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 15160
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN1001183
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401414403
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN122885
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License Number State | GA
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