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: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16689 RIVER RIDGE BLVD
WOODBRIDGE VA
22191-4630
US

IV. Provider business mailing address

16689 RIVER RIDGE BLVD
WOODBRIDGE VA
22191-4630
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-9759
  • Fax:
Mailing address:
  • Phone: 703-221-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419693
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: