Provider Demographics
NPI:1023810462
Name:SUKRITA BEDI MATTA DDS, PLLC
Entity type:Organization
Organization Name:SUKRITA BEDI MATTA DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKRITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-410-1389
Mailing Address - Street 1:1001 S HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8843
Mailing Address - Country:US
Mailing Address - Phone:908-410-1389
Mailing Address - Fax:
Practice Address - Street 1:12652 TIMBERLAND BLVD STE 130
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5528
Practice Address - Country:US
Practice Address - Phone:908-410-1389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty