=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841508611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL GULATI D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2010
-----------------------------------------------------
Last Update Date | 11/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HANSON PL SUITE 702
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11243-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-622-2695
-----------------------------------------------------
Fax | 718-638-7338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HANSON PL SUITE 702
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11243-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-622-2695
-----------------------------------------------------
Fax | 718-638-7338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 054602-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------