=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063422657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAJ PATEL DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 05/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2757 JEFFERSON DAVIS HWY SUITE 119
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-8327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-659-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2757 JEFFERSON DAVIS HWY SUITE 119
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-8327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-659-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. RAJ PATEL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 540-659-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | VA7938
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------