Provider Demographics
NPI:1952973026
Name:BAINS, SARITA
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:
Last Name:BAINS
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 1:2400 RICHMOND RD STE 133
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2464
Mailing Address - Country:US
Mailing Address - Phone:916-504-0406
Mailing Address - Fax:
Practice Address - Street 1:2400 RICHMOND RD STE 133
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2464
Practice Address - Country:US
Practice Address - Phone:903-201-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice