Provider Demographics
NPI:1356015481
Name:MAHATME, RICHA (DDS)
Entity type:Individual
Prefix:
First Name:RICHA
Middle Name:
Last Name:MAHATME
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 1:9505 49TH ST N APT 2-214
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5288
Mailing Address - Country:US
Mailing Address - Phone:551-497-0921
Mailing Address - Fax:
Practice Address - Street 1:19721 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-7807
Practice Address - Country:US
Practice Address - Phone:813-435-3462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13211122300000X
FLDN26334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist