Healthcare Provider Details

I. General information

NPI: 1568449726
Provider Name (Legal Business Name): LOKEN MUKESH PATEL D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 700
ALEXANDRIA VA
22304-1313
US

IV. Provider business mailing address

4660 KENMORE AVE SUITE 700
ALEXANDRIA VA
22304-1313
US

V. Phone/Fax

Practice location:
  • Phone: 202-679-0315
  • Fax:
Mailing address:
  • Phone: 202-679-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401412185
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: