Organization
FAYETTEVILLE ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUCHIR PATEL DDS (ORTHODONTIST)
(770) 460-6000
Entity
Organization
Contact information
Practice address
320 N JEFF DAVIS DR, SUITE C, FAYETTEVILLE, GA 30214-1669
(770) 460-6000
Mailing address
320 N JEFF DAVIS DR, SUITE C, FAYETTEVILLE, GA 30214-1669
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN04542
GA
Other
Enumeration date
12/08/2016
Last updated
12/08/2016
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