Provider Demographics
NPI:1568155794
Name:PATEL, MEGHA GIRISH (DMD)
Entity type:Individual
Prefix:
First Name:MEGHA
Middle Name:GIRISH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 BRASELTON HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4672
Mailing Address - Country:US
Mailing Address - Phone:678-897-1890
Mailing Address - Fax:
Practice Address - Street 1:3611 BRASELTON HWY STE 104
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4672
Practice Address - Country:US
Practice Address - Phone:770-945-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1235111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice