Provider Demographics
NPI:1255648606
Name:PATIL, ANURADHA (DDS)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:PATIL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PATAGONIAN PL
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4788
Mailing Address - Country:US
Mailing Address - Phone:214-802-9095
Mailing Address - Fax:
Practice Address - Street 1:4441 BASS PRO DR # 200
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4837
Practice Address - Country:US
Practice Address - Phone:972-349-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597241223G0001X
TX260751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice