Provider Demographics
NPI:1528298080
Name:PATEL, JAY VIJENDRA (DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:VIJENDRA
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 1:830 CHATBURN LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8004
Mailing Address - Country:US
Mailing Address - Phone:678-793-3053
Mailing Address - Fax:
Practice Address - Street 1:3320 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:2-F
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6542
Practice Address - Country:US
Practice Address - Phone:678-546-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2009-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice