Healthcare Provider Details

I. General information

NPI: 1861625154
Provider Name (Legal Business Name): SNEHAL PATEL, DDS, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 LORTON STATION BLVD SUITE 140
LORTON VA
22079-4792
US

IV. Provider business mailing address

604 BEULAH RD NE
VIENNA VA
22180-3511
US

V. Phone/Fax

Practice location:
  • Phone: 703-436-4633
  • Fax: 703-372-1210
Mailing address:
  • Phone: 347-886-2844
  • Fax: 703-263-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401411948
License Number StateVA

VIII. Authorized Official

Name: DR. SNEHAL PATEL
Title or Position: OWNER
Credential: DDS, MD
Phone: 347-886-2844