Provider Demographics
NPI:1386851558
Name:LUTHRA, SUCHETA (DDS, DMD)
Entity Type:Individual
Prefix:
First Name:SUCHETA
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4637
Mailing Address - Country:US
Mailing Address - Phone:304-797-7733
Mailing Address - Fax:
Practice Address - Street 1:3136 WEST STREET
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3813
Practice Address - Country:US
Practice Address - Phone:304-797-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134222000Medicaid
550629135OtherTEIN
WV0134222000Medicaid