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General NPI Number Information
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NPI Number | 1174981856
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Entity Type | Organization
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Legal Business Name | MIDLOTHIAN CHILDREN'S DENTISTRY
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 305 SCHOFIELD DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-7331
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Country | US
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Telephone | 804-517-0117
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Fax |
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Provider Business Mailing Address
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Address Line | 4717 BRYDES LN
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5827
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Country | US
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Telephone | 804-517-0117
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. SHITAL N PATEL
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Credential | DDS
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Telephone | 804-517-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401413587
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License Number State | VA
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