Radiant Dental

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

DN013402 Issued in GA

Legal business name

RADIANT DENTAL

Practice address

4745 Nelson Brogdon Blvd
Buford, GA 30518

Phone

(770) 271-4411

NPI assigned

Oct 27, 2010

Last updated

Oct 27, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nimisha PatelNPI 1194947739

Title

Dentist

Phone

(770) 271-4411

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nimisha Patel, D.D.S

  • General Practice Dentistry
  • Buford, GA
  • NPI 1194947739
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1376843078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4745 NELSON BROGDON BLVD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 NELSON BROGDON BLVD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30518",
            "telephone_number": "770-271-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "NIMISHA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-271-4411",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "GA",
            "license": "DN013402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "830482898A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Frantz Putnam, MD
• Kwang R Pyon, DMD
• Qoala Home Care, LLC (QOALA Medical Services)
• Quantum Hospice and Palliative Care LLC
• Quynh Ta PA
• Stephanie Farver Raley, MS, OTR/L
• Ram Dental, LLC
• Karina Ramos
• Sebastian Ramos
• Randolph S Moore DMD PC

• Exclusive Provider Organization in Buford, GA
• Providers in Buford, GA by specialty
• Exclusive Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.