Provider Demographics
NPI:1861625154
Name:SNEHAL PATEL, DDS, MD
Entity type:Organization
Organization Name:SNEHAL PATEL, DDS, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:347-886-2844
Mailing Address - Street 1:604 BEULAH RD NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-3511
Mailing Address - Country:US
Mailing Address - Phone:347-886-2844
Mailing Address - Fax:703-263-3148
Practice Address - Street 1:9010 LORTON STATION BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4792
Practice Address - Country:US
Practice Address - Phone:703-436-4633
Practice Address - Fax:703-372-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014119481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty