Active NPI
Nirali Patel Procter, DMD
- General Practice Dentistry
- Canton, GA
National Provider Identifier
1669450649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4088
- Practice address
- 205 Waleska Rd
Suite 2B
Canton, GA 30114-2493 - Phone
- (770) 479-1717
- NPI assigned
- Jan 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4088 | SC | Primary |
Addresses
Primary practice location
205 Waleska Rd
Suite 2B
Canton, GA 30114-2493
Mailing address
205 Waleska Rd
Suite 2B
Canton, GA 30114-2493
Phone (770) 479-1717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZX4088 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4088 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388448000000",
"number": "1669450649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 WALESKA RD",
"address_2": "SUITE 2B",
"city": "CANTON",
"state": "GA",
"postal_code": "301142493",
"telephone_number": "770-479-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 WALESKA RD",
"address_2": "SUITE 2B",
"city": "CANTON",
"state": "GA",
"postal_code": "301142493",
"telephone_number": "770-479-1717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTER",
"first_name": "NIRALI",
"middle_name": "PATEL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-09",
"last_updated": "2013-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "4088",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZX4088",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
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- Bronte M Pruitt
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.