Provider Demographics
NPI:1326936469
Name:PAVAN PUTRA SA
Entity type:Organization
Organization Name:PAVAN PUTRA SA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAAHIL
Authorized Official - Middle Name:ANIL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-815-0194
Mailing Address - Street 1:2788 STONE HALL DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5061
Mailing Address - Country:US
Mailing Address - Phone:770-815-0194
Mailing Address - Fax:
Practice Address - Street 1:319 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1539
Practice Address - Country:US
Practice Address - Phone:706-622-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental