Healthcare Provider Details

I. General information

NPI: 1366787608
Provider Name (Legal Business Name): YOGI DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 JEFFERSON DAVIS HWY STE 16
WOODBRIDGE VA
22191-2890
US

IV. Provider business mailing address

14416 JEFFERSON DAVIS HWY STE 16
WOODBRIDGE VA
22191-2890
US

V. Phone/Fax

Practice location:
  • Phone: 703-492-1999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401413519
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401412959
License Number StateVA

VIII. Authorized Official

Name: DR. MAYUR M PATEL
Title or Position: OWNER
Credential: DDS
Phone: 703-492-1999