MEDICARE: DR. ASHISH PATEL DMD, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401411990	VA

General Provider Information

NPI Number	:	1609923580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHISH PATEL DMD, MD

Provider Business Mailing Address
First Line	:	392 GARRISONVILLE RD STE 205
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-1576
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	392 GARRISONVILLE RD STE 205
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-1576
Country	:	US
Telephone Number	:	540-659-6816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	01/24/2020

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