Provider Demographics
NPI:1790995694
Name:MATTA, SUKRITA (DDS)
Entity Type:Individual
Prefix:
First Name:SUKRITA
Middle Name:
Last Name:MATTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUKRITA
Other - Middle Name:
Other - Last Name:BEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1244 SOUTHRIDGE CT
Mailing Address - Street 2:SUITE103
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4307
Mailing Address - Country:US
Mailing Address - Phone:908-410-1389
Mailing Address - Fax:
Practice Address - Street 1:1244 SOUTHRIDGE CT
Practice Address - Street 2:SUITE103
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4307
Practice Address - Country:US
Practice Address - Phone:908-410-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX307221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice