Provider Demographics
NPI:1053567800
Name:DUTTA, RICHA (BDS,DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:RICHA
Middle Name:
Last Name:DUTTA
Suffix:
Gender:F
Credentials:BDS,DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KEIL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21161-9104
Mailing Address - Country:US
Mailing Address - Phone:342-234-5407
Mailing Address - Fax:
Practice Address - Street 1:4713 HWY 121 STE 304
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2901
Practice Address - Country:US
Practice Address - Phone:972-624-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics