Provider Demographics
NPI:1033376967
Name:PATEL, DIPA JAYANTI (DDS)
Entity Type:Individual
Prefix:
First Name:DIPA
Middle Name:JAYANTI
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10418 LOWERY CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-4394
Mailing Address - Country:US
Mailing Address - Phone:703-597-5990
Mailing Address - Fax:703-566-1361
Practice Address - Street 1:3801 FAIRFAX DR
Practice Address - Street 2:SUITE 20
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:703-566-1908
Practice Address - Fax:703-566-1361
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04380002981223S0112X
MD144341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery