Provider Demographics
NPI:1477690030
Name:DUTTA, NAMITA (DDS)
Entity Type:Individual
Prefix:
First Name:NAMITA
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16466 BERNARDO CENTER DR
Mailing Address - Street 2:STE. 185
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2508
Mailing Address - Country:US
Mailing Address - Phone:858-676-1845
Mailing Address - Fax:858-676-0075
Practice Address - Street 1:16466 BERNARDO CENTER DR
Practice Address - Street 2:STE. 185
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2508
Practice Address - Country:US
Practice Address - Phone:858-676-1845
Practice Address - Fax:858-676-0075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice