Provider Demographics
NPI:1861673683
Name:JOSEPH, DHARATI ROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DHARATI
Middle Name:ROY
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 HUNTLEY DR
Mailing Address - Street 2:SUGAR LAND
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3488
Mailing Address - Country:US
Mailing Address - Phone:847-769-4765
Mailing Address - Fax:
Practice Address - Street 1:7327 HUNTLEY DR
Practice Address - Street 2:SUGAR LAND
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3488
Practice Address - Country:US
Practice Address - Phone:847-769-4765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26269122300000X
IL019.0274721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice