Provider Demographics
NPI:1972912723
Name:PATEL, JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 HALL ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3628
Mailing Address - Country:US
Mailing Address - Phone:703-231-8755
Mailing Address - Fax:
Practice Address - Street 1:7506 CANVASBACK CT
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905-7910
Practice Address - Country:US
Practice Address - Phone:703-231-8755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1230571223S0112X
VA04014144401223S0112X
VA04380004261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery