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Organization
RADIANT DENTAL
Active
Organization
RADIANT DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIMISHA PATEL (DENTIST)
(770) 271-4411
Entity
Organization
Contact information
Practice address
4745 NELSON BROGDON BLVD, BUFORD, GA 30518
(770) 271-4411
Mailing address
4745 NELSON BROGDON BLVD, BUFORD, GA 30518
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
DN013402
GA
Other
Enumeration date
10/27/2010
Last updated
10/27/2010
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