Provider Demographics
NPI:1467740043
Name:THIRTHA, MEENAL M (DMD)
Entity Type:Individual
Prefix:
First Name:MEENAL
Middle Name:M
Last Name:THIRTHA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MEENAL
Other - Middle Name:
Other - Last Name:KHAIRNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:1112 STONE GATE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4676
Mailing Address - Country:US
Mailing Address - Phone:972-948-3079
Mailing Address - Fax:
Practice Address - Street 1:2820 N O'CONNOR ROAD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-594-4888
Practice Address - Fax:972-594-4839
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28428122300000X
PADS038779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist