Provider Demographics
NPI:1205157567
Name:SAGAR, EKTA
Entity type:Individual
Prefix:
First Name:EKTA
Middle Name:
Last Name:SAGAR
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 1:2015 BOULDER SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1776
Mailing Address - Country:US
Mailing Address - Phone:917-687-2839
Mailing Address - Fax:832-595-9003
Practice Address - Street 1:7975 W GRAND PKWY S STE 120
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8603
Practice Address - Country:US
Practice Address - Phone:832-595-9000
Practice Address - Fax:832-595-9003
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310411223G0001X
MADN1855428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist