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General NPI Number Information
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NPI Number | 1013260983
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD ORAL SURGERY, PC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 6120 BRANDON AVE SUITE 301
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2522
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Country | US
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Telephone | 703-436-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 6120 BRANDON AVE SUITE 301
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SNEHAL PATEL
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Credential | DDS, MD
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Telephone | 703-436-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401411948
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License Number State | VA
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