Provider Demographics
NPI:1053606590
Name:PATEL, AMRISH DASHARATH BHAI
Entity type:Individual
Prefix:
First Name:AMRISH
Middle Name:DASHARATH BHAI
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 1:206 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5628
Mailing Address - Country:US
Mailing Address - Phone:973-610-6026
Mailing Address - Fax:
Practice Address - Street 1:1209 INDEPENDENCE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5569
Practice Address - Country:US
Practice Address - Phone:757-490-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist