Provider Demographics
NPI:1457903866
Name:RATHOD, SANKET ASHVINBHAI
Entity Type:Individual
Prefix:
First Name:SANKET
Middle Name:ASHVINBHAI
Last Name:RATHOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BROWN NODDY LN APT 406
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4324
Mailing Address - Country:US
Mailing Address - Phone:772-696-1254
Mailing Address - Fax:
Practice Address - Street 1:2560 BROWN NODDY LN APT 406
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4324
Practice Address - Country:US
Practice Address - Phone:772-696-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist