Provider Demographics
NPI:1205825817
Name:SAKALA, SUREKHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUREKHA
Middle Name:
Last Name:SAKALA
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 1:900 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2535
Mailing Address - Country:US
Mailing Address - Phone:630-892-0015
Mailing Address - Fax:630-892-9902
Practice Address - Street 1:900 N LAKE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2535
Practice Address - Country:US
Practice Address - Phone:630-892-0015
Practice Address - Fax:630-892-9902
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004389Medicaid