Provider Demographics
NPI:1982358461
Name:PATIL, MINAL GORAKHNATH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MINAL GORAKHNATH
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 1:8985 ALCOSTA BLVD APT 186
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4038
Mailing Address - Country:US
Mailing Address - Phone:215-519-5576
Mailing Address - Fax:
Practice Address - Street 1:8985 ALCOSTA BLVD APT 186
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4038
Practice Address - Country:US
Practice Address - Phone:215-519-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist