Provider Demographics
NPI:1528356607
Name:VITHLANI, DHAVAL (DDS)
Entity Type:Individual
Prefix:
First Name:DHAVAL
Middle Name:
Last Name:VITHLANI
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 1:61 ROYAL DR APT 216
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3455
Mailing Address - Country:US
Mailing Address - Phone:551-998-3158
Mailing Address - Fax:
Practice Address - Street 1:935 RIVERDALE ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4656
Practice Address - Country:US
Practice Address - Phone:413-737-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2017-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18557781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice