MEDICARE: JULITA S. PATIL D.D.S., INC.

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	261QD0000X	Dental Clinic/Center	45602	CA

General Provider Information

NPI Number	:	1811365919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULITA S. PATIL D.D.S., INC.

Provider Business Mailing Address
First Line	:	2991 TREAT BLVD STE H
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3604
Country	:	US
Telephone Number	:	925-689-2585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2991 TREAT BLVD STE H
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94518-3604
Country	:	US
Telephone Number	:	925-689-2585
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULITA SHANTAGONDA PATIL
Credential	:	D.D.S.
Telephone Number	:	925-689-2585

Provider Enumeration Date	:	09/04/2015
Last Update Date	:	09/04/2015

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