Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0438000298 | VA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 14434 | MD |
NPI | 1033376967 |
---|---|
Provider Name | Dipa Jayanti Patel |
First Address | Manassas, VA 20111-4394 |
Second Address | Arlington, VA 22203-1762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 15/12/2016 |