Provider Demographics
NPI:1356075295
Name:AK DENTAL PLLC
Entity Type:Organization
Organization Name:AK DENTAL PLLC
Other - Org Name:AK DENTAL PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:DEVISREE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEKKANTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-428-9958
Mailing Address - Street 1:16301 DONOHER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4203
Mailing Address - Country:US
Mailing Address - Phone:732-318-2848
Mailing Address - Fax:
Practice Address - Street 1:7010 W HIGHWAY 71 STE 225
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8341
Practice Address - Country:US
Practice Address - Phone:732-428-9958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AK DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-15
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45859384OtherDRIVERS LICENSE NUMBER