MEDICARE: SUKRITA BEDI MATTA DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1023810462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUKRITA BEDI MATTA DDS, PLLC

Provider Business Mailing Address
First Line	:	1001 S HOLLOW DR
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-8843
Country	:	US
Telephone Number	:	908-410-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	12652 TIMBERLAND BLVD STE 130
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5528
Country	:	US
Telephone Number	:	908-410-1389
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUKRITA MATTA
Credential	:	DDS
Telephone Number	:	908-410-1389

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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