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General NPI Number Information
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NPI Number | 1417110750
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Entity Type | Individual
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Provider Name | SHREEKRISHNA CHAITANYA AKILESH DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10550 W MARIPOSA ST
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City | PHOENIX
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State | AZ
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Zip | 85037-5081
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Country | US
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Telephone | 602-344-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 84 W ENCANTO BLVD
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City | PHOENIX
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State | AZ
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Zip | 85003-1109
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Country | US
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Telephone | 480-435-1549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22336
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8898
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License Number State | AZ
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