Provider Demographics
NPI:1093488314
Name:PATEL, MUKTI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MUKTI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23064 BROOKSBANK SQ
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4937
Mailing Address - Country:US
Mailing Address - Phone:240-527-3563
Mailing Address - Fax:
Practice Address - Street 1:25401 EASTERN MARKETPLACE PLZ STE 165
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5783
Practice Address - Country:US
Practice Address - Phone:703-542-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401417602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist