MEDICARE: ELEGANT SMILES, LLC

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	DN014427	GA

General Provider Information

NPI Number	:	1588047047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEGANT SMILES, LLC

Provider Business Mailing Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	706-409-2088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	706-409-2088
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. DIPESH PATEL
Credential	:	DMD
Telephone Number	:	706-409-2088

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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