Provider Demographics
NPI:1891086591
Name:SUTHAR, KAVITA BHALALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:BHALALA
Last Name:SUTHAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAVITA
Other - Middle Name:SURESH
Other - Last Name:BHALALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10411 MONCREIFFE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7820
Mailing Address - Country:US
Mailing Address - Phone:401-218-5014
Mailing Address - Fax:
Practice Address - Street 1:10411 MONCREIFFE RD STE 107
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7820
Practice Address - Country:US
Practice Address - Phone:919-405-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC118821223G0001X, 1223G0001X
RIDEN031891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice