Provider Demographics
NPI:1306006739
Name:PATEL, AMIT BABUBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:BABUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20600 GORDON PARK SQ
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3145
Mailing Address - Country:US
Mailing Address - Phone:703-724-4470
Mailing Address - Fax:
Practice Address - Street 1:20600 GORDON PARK SQ
Practice Address - Street 2:SUITE 110
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3145
Practice Address - Country:US
Practice Address - Phone:703-724-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice