Provider Demographics
NPI:1457975385
Name:PATEL, RICKY (DMD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 MAGNOLIA SQ
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4025
Mailing Address - Country:US
Mailing Address - Phone:229-854-6095
Mailing Address - Fax:
Practice Address - Street 1:5041 DALLAS HWY BLDG 2
Practice Address - Street 2:STE B (204)
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-3059
Practice Address - Country:US
Practice Address - Phone:229-854-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-06
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0160351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice