Provider Demographics
NPI:1972766103
Name:KRAVICH, MAHARUKH E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAHARUKH
Middle Name:E
Last Name:KRAVICH
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 1:4000 ROADSIDE CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1912
Mailing Address - Country:US
Mailing Address - Phone:312-203-1600
Mailing Address - Fax:
Practice Address - Street 1:4000 ROADSIDE CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1912
Practice Address - Country:US
Practice Address - Phone:312-203-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0192761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice