Basic Information
| Provider Information | |||||||||
| NPI: | 1689306144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | ANSH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 SHOALS RDG | ||||||||
| Address2: | |||||||||
| City: | CLARKESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305235715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782325978 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3999 AUSTELL RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707323364 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN122734 | GA | Y | Dental Providers | Dentist | General Practice |
No ID Information.