Provider Demographics
NPI:1033482500
Name:VASANI, RUPAL SURESH (MS)
Entity Type:Individual
Prefix:
First Name:RUPAL
Middle Name:SURESH
Last Name:VASANI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1422
Mailing Address - Country:US
Mailing Address - Phone:715-726-1060
Mailing Address - Fax:
Practice Address - Street 1:2501 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1422
Practice Address - Country:US
Practice Address - Phone:715-726-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6466-0151223P0700X
TX245101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics