Provider Demographics
NPI:1578005872
Name:PATIL, TULSA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TULSA
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WEST AVE
Mailing Address - Street 2:PO BOX 110233
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06911-7700
Mailing Address - Country:US
Mailing Address - Phone:508-441-9521
Mailing Address - Fax:
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-3009
Practice Address - Country:US
Practice Address - Phone:203-790-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist