Provider Demographics
NPI:1447790282
Name:PATEL, MITULKUMAR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MITULKUMAR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 MAYLAND DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4700
Mailing Address - Country:US
Mailing Address - Phone:804-270-3131
Mailing Address - Fax:
Practice Address - Street 1:8530 MAYLAND DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4700
Practice Address - Country:US
Practice Address - Phone:804-270-3131
Practice Address - Fax:804-270-2363
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014171881223P0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program