Healthcare Provider Details

I. General information

NPI: 1023562394
Provider Name (Legal Business Name): ADITI DHOLAKIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9439 LORTON MARKET ST
LORTON VA
22079-1963
US

IV. Provider business mailing address

163 FORT EVANS RD NE
LEESBURG VA
20176-4420
US

V. Phone/Fax

Practice location:
  • Phone: 217-540-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN1001634
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401415119
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: