Provider Demographics
NPI:1134474364
Name:PATIL, MADHUR (DMD)
Entity Type:Individual
Prefix:
First Name:MADHUR
Middle Name:
Last Name:PATIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PEACH ST STE 465
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2129
Mailing Address - Country:US
Mailing Address - Phone:814-456-8548
Mailing Address - Fax:
Practice Address - Street 1:1611 PEACH ST STE 465
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2129
Practice Address - Country:US
Practice Address - Phone:814-456-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice