Provider Demographics
NPI:1528475274
Name:PATEL, VIKASKUMAR
Entity type:Individual
Prefix:
First Name:VIKASKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18121 GEORGIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1437
Mailing Address - Country:US
Mailing Address - Phone:240-390-0290
Mailing Address - Fax:
Practice Address - Street 1:18121 GEORGIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1437
Practice Address - Country:US
Practice Address - Phone:240-390-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist