Provider Demographics
NPI:1154206100
Name:PATI, RUSHITA
Entity type:Individual
Prefix:
First Name:RUSHITA
Middle Name:
Last Name:PATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 MILE HIGH STADIUM CIR APT 602
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2762
Mailing Address - Country:US
Mailing Address - Phone:310-447-1887
Mailing Address - Fax:
Practice Address - Street 1:7479 E 29TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2704
Practice Address - Country:US
Practice Address - Phone:802-734-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00206404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist