Healthcare Provider Details

I. General information

NPI: 1912893249
Provider Name (Legal Business Name): KISHORI DINESH PATEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 LEE HWY
FAIRFAX VA
22030
US

IV. Provider business mailing address

1800 N OAK ST APT 1414
ARLINGTON VA
22209-2613
US

V. Phone/Fax

Practice location:
  • Phone: 703-520-6376
  • Fax:
Mailing address:
  • Phone: 813-527-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number18693
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2001555
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419693
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: