Provider Demographics
NPI:1548598576
Name:PATIL, CHETAN SHYAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:SHYAM
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 1:5526 N 79TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6503
Mailing Address - Country:US
Mailing Address - Phone:201-468-2692
Mailing Address - Fax:
Practice Address - Street 1:4025 W BELL RD STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2748
Practice Address - Country:US
Practice Address - Phone:480-744-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538231223P0300X
NJ22DI024294001223P0300X
AZD0102741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics