Healthcare Provider Details

I. General information

NPI: 1700463056
Provider Name (Legal Business Name): AMBE PERIO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 MEMORY LN STE A
CHESTERFIELD VA
23832-8832
US

IV. Provider business mailing address

10320 MEMORY LN STE A
CHESTERFIELD VA
23832-8832
US

V. Phone/Fax

Practice location:
  • Phone: 804-748-9553
  • Fax: 804-748-0460
Mailing address:
  • Phone: 804-748-9553
  • Fax: 804-748-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MITULKUMAR PATEL
Title or Position: PERIODONTIST/OWNER
Credential: DDS, MS
Phone: 470-313-2907