Provider Demographics
NPI:1295224707
Name:ABHISHEK RAYTHATHA, DDS, INC
Entity Type:Organization
Organization Name:ABHISHEK RAYTHATHA, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABHISHEK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYTHATHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-785-7437
Mailing Address - Street 1:9833 FAIR OAKS BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7042
Mailing Address - Country:US
Mailing Address - Phone:916-967-2217
Mailing Address - Fax:
Practice Address - Street 1:9833 FAIR OAKS BLVD STE E
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7042
Practice Address - Country:US
Practice Address - Phone:916-967-2217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherACCEPTING ALL PPO INSURANCES