Provider Demographics
NPI:1619120722
Name:PATWARDHAN, MUGDHA VINOD (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:MUGDHA
Middle Name:VINOD
Last Name:PATWARDHAN
Suffix:
Gender:F
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 W PORTAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1303
Mailing Address - Country:US
Mailing Address - Phone:415-661-6006
Mailing Address - Fax:415-661-6115
Practice Address - Street 1:99 W PORTAL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127
Practice Address - Country:US
Practice Address - Phone:415-661-6006
Practice Address - Fax:415-661-6115
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2431781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery