Provider Demographics
NPI:1023365863
Name:PATHAK, RAHUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:PATHAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OSCAWANA LAKE RD
Mailing Address - Street 2:PO BOX 670
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 OSCAWANA LAKE RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3003
Practice Address - Country:US
Practice Address - Phone:845-528-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568401223G0001X
CT0109421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice