Provider Demographics
NPI:1649612144
Name:PATEL, DIPESHKUMAR DHANSUKH (DMD)
Entity type:Individual
Prefix:DR
First Name:DIPESHKUMAR
Middle Name:DHANSUKH
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 1:12460 CRABAPPLE RD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6602
Mailing Address - Country:US
Mailing Address - Phone:256-673-1082
Mailing Address - Fax:
Practice Address - Street 1:12460 CRABAPPLE RD
Practice Address - Street 2:SUITE 801
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6602
Practice Address - Country:US
Practice Address - Phone:256-673-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6038122300000X
GADN014802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist