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General NPI Number Information
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NPI Number | 1023810462
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Entity Type | Organization
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Legal Business Name | SUKRITA BEDI MATTA DDS, PLLC
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 12652 TIMBERLAND BLVD STE 130
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City | FORT WORTH
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State | TX
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Zip | 76244-5528
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Country | US
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Telephone | 908-410-1389
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 S HOLLOW DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8843
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Country | US
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Telephone | 908-410-1389
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUKRITA MATTA
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Credential | DDS
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Telephone | 908-410-1389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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