Provider Demographics
NPI:1134520620
Name:RAKALLA, AMRITA KAUR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:KAUR
Last Name:RAKALLA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GRANT SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3383
Mailing Address - Country:US
Mailing Address - Phone:630-323-1201
Mailing Address - Fax:
Practice Address - Street 1:1 GRANT SQ STE 101
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3383
Practice Address - Country:US
Practice Address - Phone:630-323-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-029080122300000X
IL0210026291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist