NPI 1376843078

Radiant Dental

Organisation Exclusive Provider Organization Buford, GA

Practice location

Address: 4745 Nelson Brogdon Blvd, Buford, GA 30518
Phone: (770) 271-4411

Authorised official

Name: Nimisha Patel
Title: Dentist
Phone: (770) 271-4411

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence DN013402 (GA)

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Registry record

NPI: 1376843078
Entity type: Organization
NPI issued: 27 Oct 2010
Record last updated: 27 Oct 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.