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NPI Code Detail

MEDICARE: MAITHILI BAPAT MARATHE D.D.S.

MEDICARE: MAITHILI BAPAT MARATHE D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist100336CA

General Provider Information

NPI Number : 1043663479
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAITHILI BAPAT MARATHE D.D.S.
Provider Business Mailing Address
First Line : 28 COUNTRY RIDGE RD
Second Line :
City : POMONA
State : CA
Zip : 91766-4815
Country : US
Telephone Number : 909-374-1731
Fax Number :
Provider Business Practice Location Address
First Line : 6437 E PACIFIC COAST HWY
Second Line : UNIT A-6
City : LONG BEACH
State : CA
Zip : 90803-4201
Country : US
Telephone Number : 562-735-3623
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2016
Last Update Date : 07/20/2016

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