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General NPI Number Information
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NPI Number | 1609128818
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Entity Type | Organization
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Legal Business Name | SUKET PC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 1235 INDIAN TRAIL RD
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City | NORCROSS
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State | GA
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Zip | 30093-4502
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Country | US
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Telephone | 770-931-1333
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 INDIAN TRAIL RD
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City | NORCROSS
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State | GA
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Zip | 30093-4502
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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 | DENTIST
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Name | DR. KETANKUMAR G PATEL
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Credential | DMD
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Telephone | 770-931-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012835
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN012835
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License Number State | GA
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