Healthcare Provider Details

I. General information

NPI: 1447839600
Provider Name (Legal Business Name): SATPAL S JUTLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WELLS ST
WESTERLY RI
02891-2959
US

IV. Provider business mailing address

11 WELLS ST
WESTERLY RI
02891-2959
US

V. Phone/Fax

Practice location:
  • Phone: 860-518-8068
  • Fax:
Mailing address:
  • Phone: 860-518-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13241
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: