Provider Demographics
NPI:1376983494
Name:VISHWAMITRA, ANKITA (BDS)
Entity Type:Individual
Prefix:DR
First Name:ANKITA
Middle Name:
Last Name:VISHWAMITRA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 JUANCHIDO LN
Mailing Address - Street 2:
Mailing Address - City:YSLETA DEL SUR PUEBLO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-6832
Mailing Address - Country:US
Mailing Address - Phone:915-858-1076
Mailing Address - Fax:
Practice Address - Street 1:9314 JUANCHIDO LN
Practice Address - Street 2:
Practice Address - City:YSLETA DEL SUR PUEBLO
Practice Address - State:TX
Practice Address - Zip Code:79907-6832
Practice Address - Country:US
Practice Address - Phone:915-858-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist