Provider Demographics
NPI:1093056202
Name:GUTTIKONDA, BHARAT RAM CHOWDRY (DDS)
Entity Type:Individual
Prefix:
First Name:BHARAT RAM CHOWDRY
Middle Name:
Last Name:GUTTIKONDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BHARAT RAM
Other - Middle Name:CHOWDRY
Other - Last Name:GUTTIKONDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:1998 N MOTEL BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4100
Practice Address - Country:US
Practice Address - Phone:575-541-5941
Practice Address - Fax:575-541-5048
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX286481223G0001X
NMDD4457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice