MEDICARE: DR. PRANAY VISHRUT PATEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401419900	VA

General Provider Information

NPI Number	:	1205460094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRANAY VISHRUT PATEL DDS

Provider Business Mailing Address
First Line	:	11800 SUNRISE VALLEY DR STE 250
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-5302
Country	:	US
Telephone Number	:	703-429-9926
Fax Number	:

Provider Business Practice Location Address
First Line	:	11800 SUNRISE VALLEY DR STE 250
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-5302
Country	:	US
Telephone Number	:	703-429-9926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2020
Last Update Date	:	03/17/2026

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