Provider Demographics
NPI:1639268907
Name:DUTTA, OSHMI (BDS, DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:OSHMI
Middle Name:
Last Name:DUTTA
Suffix:
Gender:M
Credentials:BDS, DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 PRESCOTT OAKS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3851
Mailing Address - Country:US
Mailing Address - Phone:425-785-6000
Mailing Address - Fax:210-625-7398
Practice Address - Street 1:18707 HARDY OAK BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4791
Practice Address - Country:US
Practice Address - Phone:210-888-0700
Practice Address - Fax:210-625-7398
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8231122300000X
TX252591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist