Provider Demographics
NPI:1780350884
Name:GHETIA, EKTA S (DMD)
Entity type:Individual
Prefix:
First Name:EKTA
Middle Name:S
Last Name:GHETIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:EKTA
Other - Middle Name:K
Other - Last Name:KHIRSARIYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:310 CRESCENT VILLAGE CIR UNIT 1220
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3041
Mailing Address - Country:US
Mailing Address - Phone:347-257-6414
Mailing Address - Fax:
Practice Address - Street 1:4205 SAN FELIPE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1546
Practice Address - Country:US
Practice Address - Phone:408-270-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS106560122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist