Provider Demographics
NPI:1396265542
Name:GHANTA, HARITHA (DMD)
Entity type:Individual
Prefix:DR
First Name:HARITHA
Middle Name:
Last Name:GHANTA
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 1:200 COMPASS DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3869
Mailing Address - Country:US
Mailing Address - Phone:845-546-6618
Mailing Address - Fax:
Practice Address - Street 1:200 COMPASS DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3869
Practice Address - Country:US
Practice Address - Phone:845-546-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist