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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
830482898A
—
GA
Enumeration date
10/27/2010
Last updated
10/27/2010
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