Provider Demographics
NPI:1770777849
Name:DISICK, RITU SOOD (DDS)
Entity type:Individual
Prefix:DR
First Name:RITU
Middle Name:SOOD
Last Name:DISICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:RITU
Other - Middle Name:
Other - Last Name:SOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:591 REDWOOD HWY
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-6001
Mailing Address - Country:US
Mailing Address - Phone:415-381-4321
Mailing Address - Fax:
Practice Address - Street 1:591 REDWOOD HWY
Practice Address - Street 2:SUITE 2110
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-6001
Practice Address - Country:US
Practice Address - Phone:415-381-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice