Provider Demographics
NPI:1770671505
Name:GHOSH, PRITA (DDS)
Entity Type:Individual
Prefix:
First Name:PRITA
Middle Name:
Last Name:GHOSH
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 1:2009 SAINT THOMAS DR APT 220
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2175
Mailing Address - Country:US
Mailing Address - Phone:301-870-4553
Mailing Address - Fax:301-870-7034
Practice Address - Street 1:117 SAINT PATRICKS DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4574
Practice Address - Country:US
Practice Address - Phone:301-870-4553
Practice Address - Fax:301-870-7034
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice