Provider Demographics
NPI:1063422657
Name:RAJ PATEL DDS INC
Entity type:Organization
Organization Name:RAJ PATEL DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-659-2000
Mailing Address - Street 1:2757 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 119
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8327
Mailing Address - Country:US
Mailing Address - Phone:540-659-2000
Mailing Address - Fax:
Practice Address - Street 1:2757 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 119
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8327
Practice Address - Country:US
Practice Address - Phone:540-659-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA7938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty