Provider Demographics
NPI:1164686770
Name:SHANKARALINGAPPA, ARCHANA SHETTIKERE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:SHETTIKERE
Last Name:SHANKARALINGAPPA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 E LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-269-8986
Practice Address - Street 1:5730 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4366
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN233081223G0001X
MA222311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100303200Medicaid