Provider Demographics
NPI:1013115021
Name:PATEL, VAIBHAVI SIDDHARTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAIBHAVI
Middle Name:SIDDHARTH
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 1:500 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4622
Mailing Address - Country:US
Mailing Address - Phone:434-797-4200
Mailing Address - Fax:434-797-2365
Practice Address - Street 1:500 PARK AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4622
Practice Address - Country:US
Practice Address - Phone:434-797-4200
Practice Address - Fax:434-797-2365
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10131150211223G0001X
NC96501223G0001X, 122300000X
VA0401412342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice