Provider Demographics
NPI:1255727376
Name:KATHURIA, DIKSHANT (DDS)
Entity type:Individual
Prefix:
First Name:DIKSHANT
Middle Name:
Last Name:KATHURIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PASTURE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2323
Mailing Address - Country:US
Mailing Address - Phone:734-680-5766
Mailing Address - Fax:
Practice Address - Street 1:33 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424
Practice Address - Country:US
Practice Address - Phone:734-680-5766
Practice Address - Fax:860-267-7742
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT115731223G0001X
PADS0404401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice