MEDICARE: RAHUL PATEL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	6001166-15	WI

General Provider Information

NPI Number	:	1679261960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAHUL PATEL DMD

Provider Business Mailing Address
First Line	:	607 S MUSKET RIDGE DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-3427
Country	:	US
Telephone Number	:	732-331-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1853 NORTHPORT DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-3027
Country	:	US
Telephone Number	:	732-331-7222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	06/06/2023

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