# RADIANT DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376843078
- **Authorized official:** DR. NIMISHA PATEL (DENTIST)
- **Authorized official phone:** (770) 271-4411

## Contact information

- **Practice address:** 4745 NELSON BROGDON BLVD, BUFORD, GA 30518
- **Practice address phone:** (770) 271-4411
- **Mailing address:** 4745 NELSON BROGDON BLVD, BUFORD, GA 30518

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | DN013402 | GA | Yes |

## Other

- **Enumeration date:** 10/27/2010
- **Last updated:** 10/27/2010