Provider Demographics
NPI:1356014633
Name:ALTEKREETI, TUKA
Entity type:Individual
Prefix:
First Name:TUKA
Middle Name:
Last Name:ALTEKREETI
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 1:1304 W DAVIS ST STE A
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2338
Mailing Address - Country:US
Mailing Address - Phone:859-494-0620
Mailing Address - Fax:
Practice Address - Street 1:1304 W DAVIS ST STE A
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2338
Practice Address - Country:US
Practice Address - Phone:936-209-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014175891223G0001X
TX390251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice