MEDICARE: DR. PARUL JAIN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN614709	GA
2	1223G0001X	General Practice Dentistry	054076	NY
3	1223G0001X	General Practice Dentistry	014709	GA

General Provider Information

NPI Number	:	1417193897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARUL JAIN D.D.S

Provider Business Mailing Address
First Line	:	1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4154
Country	:	US
Telephone Number	:	404-777-7147
Fax Number	:	404-777-7147

Provider Business Practice Location Address
First Line	:	1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4154
Country	:	US
Telephone Number	:	404-777-7147
Fax Number	:	404-777-7147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	10/28/2021

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