Provider Demographics
NPI:1407186752
Name:BILAKANTI, SUPRAJA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUPRAJA
Middle Name:
Last Name:BILAKANTI
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 1:400 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5980
Mailing Address - Country:US
Mailing Address - Phone:770-916-5352
Mailing Address - Fax:678-247-7862
Practice Address - Street 1:400C SOUTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2974
Practice Address - Country:US
Practice Address - Phone:800-904-5665
Practice Address - Fax:678-904-5666
Is Sole Proprietor?:No
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice