Healthcare Provider Details

I. General information

NPI: 1003093410
Provider Name (Legal Business Name): ALIA CHAKAKI DDS,MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 LOUETTA RD SUITE #400
HOUSTON TX
77070-1368
US

IV. Provider business mailing address

1218 SW MILITARY DR
SAN ANTONIO TX
78221-1535
US

V. Phone/Fax

Practice location:
  • Phone: 281-320-0400
  • Fax: 281-320-9764
Mailing address:
  • Phone: 210-928-2814
  • Fax: 210-579-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number23226
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: