MEDICARE: DR. KALINDI NITAL PATWA D.M.D.

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
1	122300000X	Dentist	44054	CA

General Provider Information

NPI Number	:	1467667238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALINDI NITAL PATWA D.M.D.

Provider Business Mailing Address
First Line	:	716 ASHTON OAKS WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1312
Country	:	US
Telephone Number	:	408-227-1984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2664 BERRYESSA RD
Second Line	:	SUITE 107
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2925
Country	:	US
Telephone Number	:	408-258-1323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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