Provider Demographics
NPI:1215541677
Name:PATEL, KAUSHAL (DDS)
Entity type:Individual
Prefix:
First Name:KAUSHAL
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 AUGUSTA RD UNIT 18371
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31418-7963
Mailing Address - Country:US
Mailing Address - Phone:478-595-5031
Mailing Address - Fax:
Practice Address - Street 1:1458 CHURCH ST STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1672
Practice Address - Country:US
Practice Address - Phone:870-935-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR44591223G0001X
GADN1225421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice