Individual provider Active NPI

Ricky Patel, DMD

  • Dentist
  • Canton, GA
National Provider Identifier
1740636166
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN015351 Issued in GA
Practice address
8701 Knox Bridge Hwy
Canton, GA 30114-4541
Phone
(205) 934-2700
NPI assigned
May 5, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN015351 GA Primary

Addresses

Primary practice location

8701 Knox Bridge Hwy
Canton, GA 30114-4541

Mailing address

1015 Woodbury Rd
Canton, GA 30114
Phone (404) 543-4401

Other practice location 1

5975 Roswell Rd Ste D229
Sandy Springs, GA 30328-4045
Phone (678) 701-6753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161010000067 AL Order and Referring Only - DentistPractitioner - Dentist 2668760547

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN015351GAMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1740636166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 WOODBURY RD",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "404-543-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8701 KNOX BRIDGE HWY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301144541",
            "telephone_number": "205-934-2700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5975 Roswell Rd Ste D229",
            "address_purpose": "LOCATION",
            "city": "Sandy Springs",
            "state": "GA",
            "postal_code": "303284045",
            "country_code": "US",
            "telephone_number": "678-701-6753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PATEL",
        "first_name": "RICKY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-05",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN015351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.