Provider Demographics
NPI:1063853125
Name:LALA, HARIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARIKA
Middle Name:
Last Name:LALA
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 1:4021 REGGIS CT
Mailing Address - Street 2:SUITE # 313
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-3957
Mailing Address - Country:US
Mailing Address - Phone:469-247-1332
Mailing Address - Fax:
Practice Address - Street 1:4021 REGGIS CT
Practice Address - Street 2:SUITE # 313
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-3957
Practice Address - Country:US
Practice Address - Phone:469-247-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6536122300000X
TX29726122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist