Provider Demographics
NPI:1427139104
Name:PATEL, BHAVIK M (DDS)
Entity type:Individual
Prefix:
First Name:BHAVIK
Middle Name:M
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 1:4574 LAWRENCEVILLE HWY NW STE 120
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3605
Mailing Address - Country:US
Mailing Address - Phone:770-927-9000
Mailing Address - Fax:
Practice Address - Street 1:4574 LAWRENCEVILLE HWY NW STE 120
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3605
Practice Address - Country:US
Practice Address - Phone:770-927-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA689329146AMedicaid