Healthcare Provider Details

I. General information

NPI: 1417090390
Provider Name (Legal Business Name): NEEL SATISH SATPUTE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NEEL SATISH SATPUTE D.D.S.

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DR SUITE 190
BALTIMORE MD
21209-3742
US

IV. Provider business mailing address

2700 QUARRY LAKE DR SUITE 190
BALTIMORE MD
21209-3742
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-4401
  • Fax:
Mailing address:
  • Phone: 410-484-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number48675
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS035689
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13957
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: