Healthcare Provider Details

I. General information

NPI: 1801180054
Provider Name (Legal Business Name): PAYAL PATEL GOLA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAYAL MUKESH PATEL DMD

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14573 POTOMAC MILLS RD
WOODBRIDGE VA
22192-6808
US

IV. Provider business mailing address

812 S GREENBRIER ST
ARLINGTON VA
22204-2704
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-4746
  • Fax: 202-269-6994
Mailing address:
  • Phone: 423-400-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401415944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: