Healthcare Provider Details

I. General information

NPI: 1699844266
Provider Name (Legal Business Name): AJIT A PATEL D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42882 TRURO PARISH DR SUITE 205
BROADLANDS VA
20148-4456
US

IV. Provider business mailing address

42882 TRURO PARISH DR SUITE 205
BROADLANDS VA
20148-4456
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-4333
  • Fax: 703-726-4334
Mailing address:
  • Phone: 703-726-4333
  • Fax: 703-726-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: