Provider Demographics
NPI:1184904872
Name:RAJENDRAN, AKILA (DDS)
Entity type:Individual
Prefix:
First Name:AKILA
Middle Name:
Last Name:RAJENDRAN
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 1:10877 MORRO BAY LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6714
Mailing Address - Country:US
Mailing Address - Phone:512-968-0995
Mailing Address - Fax:
Practice Address - Street 1:10877 MORRO BAY LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6714
Practice Address - Country:US
Practice Address - Phone:512-968-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist