Provider Demographics
NPI:1194947739
Name:PATEL, NIMISHA (DDS)
Entity type:Individual
Prefix:DR
First Name:NIMISHA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 NELSON BROGDON BLVD.
Mailing Address - Street 2:SUITE - 100
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518
Mailing Address - Country:US
Mailing Address - Phone:770-271-4411
Mailing Address - Fax:770-271-4499
Practice Address - Street 1:4745 NELSON BROGDON BLVD.
Practice Address - Street 2:SUITE - 100
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:770-945-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0134021223G0001X
GADN03402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist