Healthcare Provider Details

I. General information

NPI: 1033376967
Provider Name (Legal Business Name): DIPA JAYANTI PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 FAIRFAX DR SUITE 20
ARLINGTON VA
22203-1762
US

IV. Provider business mailing address

10418 LOWERY CT
MANASSAS VA
20111-4394
US

V. Phone/Fax

Practice location:
  • Phone: 703-566-1908
  • Fax: 703-566-1361
Mailing address:
  • Phone: 703-597-5990
  • Fax: 703-566-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0438000298
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14434
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: