Provider Demographics
NPI:1972819985
Name:VARTIKAR, PRACHI (DMD)
Entity type:Individual
Prefix:
First Name:PRACHI
Middle Name:
Last Name:VARTIKAR
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 1:3704 CHEEK-SPARGER ROAD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:682-703-0101
Mailing Address - Fax:
Practice Address - Street 1:3704 CHEEK-SPARGER ROAD
Practice Address - Street 2:SUITE100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76201
Practice Address - Country:US
Practice Address - Phone:682-703-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX025677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25677Medicaid
TX216389113Medicaid