Healthcare Provider Details

I. General information

NPI: 1659094902
Provider Name (Legal Business Name): RITU TIWARI MDS BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CAMBRIDGE ST STE 5364
HOUSTON TX
77054-2032
US

IV. Provider business mailing address

7500 CAMBRIDGE ST STE 5364
HOUSTON TX
77054-2032
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-4419
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number39285
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License NumberDE61353037
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: