Provider Demographics
NPI:1417333881
Name:MUKKA, SPANDANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SPANDANA
Middle Name:
Last Name:MUKKA
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 1:970 NORTHWOODS DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3803
Mailing Address - Country:US
Mailing Address - Phone:919-465-0799
Mailing Address - Fax:
Practice Address - Street 1:970 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3803
Practice Address - Country:US
Practice Address - Phone:919-465-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150266141223G0001X
NC113771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice