Provider Demographics
NPI:1720058217
Name:PATEL, JAYESH SURENDRA (BDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JAYESH
Middle Name:SURENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:BDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21487 DOWNING CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5812
Mailing Address - Country:US
Mailing Address - Phone:703-724-9282
Mailing Address - Fax:
Practice Address - Street 1:4210 FAIRFAX CORNER WEST AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8619
Practice Address - Country:US
Practice Address - Phone:703-361-1136
Practice Address - Fax:703-631-1337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics