Provider Demographics
NPI:1649307323
Name:PATIL, SUDHA PANDIT (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:PANDIT
Last Name:PATIL
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 LAUREL STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701
Mailing Address - Country:US
Mailing Address - Phone:540-727-0122
Mailing Address - Fax:540-727-0244
Practice Address - Street 1:691 LAUREL STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701
Practice Address - Country:US
Practice Address - Phone:540-727-0122
Practice Address - Fax:540-727-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069851223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics