Provider Demographics
NPI:1366560930
Name:DOCTOR, EKTA M (DMD)
Entity type:Individual
Prefix:
First Name:EKTA
Middle Name:M
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 RICCIUTI DR
Mailing Address - Street 2:APARTMENT 1321
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6287
Mailing Address - Country:US
Mailing Address - Phone:617-273-0627
Mailing Address - Fax:
Practice Address - Street 1:561 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1817
Practice Address - Country:US
Practice Address - Phone:781-335-4900
Practice Address - Fax:781-335-6953
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA213981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice