Provider Demographics
NPI:1417110750
Name:AKILESH, SHREEKRISHNA CHAITANYA (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHREEKRISHNA
Middle Name:CHAITANYA
Last Name:AKILESH
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 W ENCANTO BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1109
Mailing Address - Country:US
Mailing Address - Phone:480-435-1549
Mailing Address - Fax:
Practice Address - Street 1:10550 W MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5081
Practice Address - Country:US
Practice Address - Phone:602-344-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223361223P0221X
AZ88981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry