Provider Demographics
NPI:1750793477
Name:PATEL, RAJ (DDS)
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:
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 1:2757 JEFFERSON DAVIS HWY STE 119
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8328
Mailing Address - Country:US
Mailing Address - Phone:540-455-9697
Mailing Address - Fax:
Practice Address - Street 1:2757 JEFFERSON DAVIS HWY STE 119
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8328
Practice Address - Country:US
Practice Address - Phone:540-455-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063422657OtherNPI-ORGANIZATIONAL