Provider Demographics
NPI:1285243303
Name:PATEL, VICKIE M (DMD)
Entity type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 CONNECTICUT AVE NW STE 419
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-6021
Mailing Address - Country:US
Mailing Address - Phone:202-244-8848
Mailing Address - Fax:
Practice Address - Street 1:4545 CONNECTICUT AVE NW STE 419
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6021
Practice Address - Country:US
Practice Address - Phone:202-244-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1002149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist