Provider Demographics
NPI:1619346970
Name:GARG, YUKTI
Entity Type:Individual
Prefix:
First Name:YUKTI
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 S SIGNAL BUTTE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-3908
Mailing Address - Country:US
Mailing Address - Phone:480-582-1199
Mailing Address - Fax:
Practice Address - Street 1:1113 S SIGNAL BUTTE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-3908
Practice Address - Country:US
Practice Address - Phone:480-582-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0104731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31860OtherTEXAS DENTAL LICENSE
AZD010473OtherARIZONA DENTAL LICENSE