Provider Demographics
NPI:1669680864
Name:PUROHIT, VASANTKUMAR KESHAVCHANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VASANTKUMAR
Middle Name:KESHAVCHANDRA
Last Name:PUROHIT
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 1:2 RUBINSTEIN CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1821
Mailing Address - Country:US
Mailing Address - Phone:845-425-9353
Mailing Address - Fax:845-425-9353
Practice Address - Street 1:15 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5533
Practice Address - Country:US
Practice Address - Phone:845-425-9353
Practice Address - Fax:845-425-9353
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0356721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00606111Medicaid