Provider Demographics
NPI:1114074408
Name:MIKKILINENI, BABITA (DMD)
Entity Type:Individual
Prefix:
First Name:BABITA
Middle Name:
Last Name:MIKKILINENI
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 1:430 W ERIE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-4032
Mailing Address - Country:US
Mailing Address - Phone:920-838-1649
Mailing Address - Fax:
Practice Address - Street 1:3434 W. ILLINOIS AVE, SUITE 307
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-339-3900
Practice Address - Fax:214-339-3908
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice