Provider Demographics
NPI:1790262079
Name:BANSAL, RITIKA
Entity Type:Individual
Prefix:
First Name:RITIKA
Middle Name:
Last Name:BANSAL
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 1:197 JUDITH LN APT 1
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1944
Mailing Address - Country:US
Mailing Address - Phone:317-650-8604
Mailing Address - Fax:
Practice Address - Street 1:3401 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2501
Practice Address - Country:US
Practice Address - Phone:202-829-5437
Practice Address - Fax:202-829-9255
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12264122300000X
DCDEN2000027122300000X
GADN123053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist