Healthcare Provider Details

I. General information

NPI: 1346463395
Provider Name (Legal Business Name): RAJESH R PATIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 MITCHELL WAY STE 106
ERIE CO
80516-5438
US

IV. Provider business mailing address

4220 PRAIRIE FIRE CIR
LONGMONT CO
80503-6414
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-7722
  • Fax:
Mailing address:
  • Phone: 720-438-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDEN7680
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: