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114 Mirramont Lake Dr Woodstock GA 30189-8213 | |
| (770) 592-7000 | |
| (770) 517-7403 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 114 Mirramont Lake Dr, Woodstock, Georgia |
| Authorized Official Name and Position | Hiral Ankur Patel (OWNER/MANAGER) |
| Authorized Official Contact | 7063469516 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
114 Mirramont Lake Dr Woodstock GA 30189-8213 Ph: (770) 592-7000 | 114 Mirramont Lake Dr Woodstock GA 30189-8213 Ph: (770) 592-7000 |
| NPI Number | 1710304373 |
|---|---|
| Provider Enumeration Date | 03/20/2014 |
| Last Update Date | 03/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710304373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | LC20140000214 (Georgia) | Primary |
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