Provider Demographics
NPI:1972734705
Name:PATEL, SHITAL N (DDS)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:N
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 1:305 SCHOFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-7331
Mailing Address - Country:US
Mailing Address - Phone:804-601-3139
Mailing Address - Fax:804-451-5993
Practice Address - Street 1:305 SCHOFIELD DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7331
Practice Address - Country:US
Practice Address - Phone:804-601-3139
Practice Address - Fax:804-451-5993
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413587122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN
VAC06778OtherGROUP PTAN