Provider Demographics
NPI:1922483890
Name:SRIVASTAVA, AKANKSHA (BDS, MSC, MDSC)
Entity Type:Individual
Prefix:DR
First Name:AKANKSHA
Middle Name:
Last Name:SRIVASTAVA
Suffix:
Gender:F
Credentials:BDS, MSC, MDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4353
Mailing Address - Country:US
Mailing Address - Phone:312-996-7546
Mailing Address - Fax:
Practice Address - Street 1:811 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4353
Practice Address - Country:US
Practice Address - Phone:312-996-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0331231223P0700X
TX348191223P0700X
IL0190331231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty