Healthcare Provider Details

I. General information

NPI: 1154244713
Provider Name (Legal Business Name): RITHIKA RAVISHANKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 OLD AUSTIN HWY STE 400
BASTROP TX
78602-5165
US

IV. Provider business mailing address

1120 TOWN CREEK DR UNIT 611
AUSTIN TX
78741-1541
US

V. Phone/Fax

Practice location:
  • Phone: 512-212-9803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: