Healthcare Provider Details

I. General information

NPI: 1972646685
Provider Name (Legal Business Name): SUNJAY VIJAY PATIL D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 AQUIDNECK AVE STE 203
MIDDLETOWN RI
02842-7265
US

IV. Provider business mailing address

747 AQUIDNECK AVE STE 203
MIDDLETOWN RI
02842-7265
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-9660
  • Fax: 401-846-9667
Mailing address:
  • Phone: 401-846-9660
  • Fax: 401-846-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2714
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: