Provider Demographics
NPI:1235708280
Name:AKILLA, LAXMI PRANATI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAXMI
Middle Name:PRANATI
Last Name:AKILLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PRANATI
Other - Middle Name:
Other - Last Name:AKILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:100 CORRAL WAY APT B
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7262
Mailing Address - Country:US
Mailing Address - Phone:313-603-7520
Mailing Address - Fax:
Practice Address - Street 1:2306 1ST AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2527
Practice Address - Country:US
Practice Address - Phone:620-225-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS619001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice