# INSTITUTE OF FACIAL & ORAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225305766
- **Authorized official:** DR. SUKETU I PATEL M.D., D.M.D. (PART OWNER)
- **Authorized official phone:** (703) 729-0077

## Contact information

- **Practice address:** 44115 WOODRIDGE PKWY, SUITE 200, LEESBURG, VA 20176-5199
- **Practice address phone:** (703) 729-0077
- **Practice address fax:** (703) 729-6696
- **Mailing address:** 44115 WOODRIDGE PKWY, SUITE 200, LEESBURG, VA 20176-5199
- **Mailing address phone:** (703) 729-0077
- **Mailing address fax:** (703) 729-6696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0401413011 | VA | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 101238043 | VA | — |

## Other

- **Enumeration date:** 11/29/2011
- **Last updated:** 11/29/2011