Provider Demographics
NPI:1942463393
Name:POPAT, RISHI (DMD, DMSC)
Entity Type:Individual
Prefix:DR
First Name:RISHI
Middle Name:
Last Name:POPAT
Suffix:
Gender:M
Credentials:DMD, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1133
Mailing Address - Country:US
Mailing Address - Phone:602-265-0303
Mailing Address - Fax:602-783-1365
Practice Address - Street 1:635 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1133
Practice Address - Country:US
Practice Address - Phone:602-265-0303
Practice Address - Fax:602-783-1365
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101251223G0001X
AZD076401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice