Provider Demographics
NPI:1346463395
Name:PATIL, RAJESH R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:R
Last Name:PATIL
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 1:4220 PRAIRIE FIRE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6414
Mailing Address - Country:US
Mailing Address - Phone:720-438-1860
Mailing Address - Fax:
Practice Address - Street 1:615 MITCHELL WAY STE 106
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-5438
Practice Address - Country:US
Practice Address - Phone:303-772-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN76801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics