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General NPI Number Information
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NPI Number | 1841319449
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Entity Type | Organization
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Legal Business Name | GAINESVILLE DENTAL CENTER
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 1586 PARK HILL DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-1950
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Country | US
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Telephone | 770-534-0697
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Fax | 770-534-1724
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Provider Business Mailing Address
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Address Line | 1586 PARK HILL DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-1950
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Country | US
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Telephone | 770-534-0697
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Fax | 770-534-1724
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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 | D.M.D.
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Telephone | 770-534-0697
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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 | DN012835
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN008017
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN007359
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License Number State | GA
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