Provider Demographics
NPI:1831374222
Name:PUTHALPET, GEETANJALI (DMD)
Entity type:Individual
Prefix:DR
First Name:GEETANJALI
Middle Name:
Last Name:PUTHALPET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTGATE DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1810
Mailing Address - Country:US
Mailing Address - Phone:508-583-3840
Mailing Address - Fax:
Practice Address - Street 1:200 WESTGATE DR
Practice Address - Street 2:SUITE 135
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1810
Practice Address - Country:US
Practice Address - Phone:508-583-3840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice