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General NPI Number Information
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NPI Number | 1699753319
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Entity Type | Individual
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Provider Name | SREENIVAS KOKA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 201 BAKER BLVD
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City | LELAND
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State | MS
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Zip | 38756-3401
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Country | US
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Telephone | 662-686-4121
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Fax | 662-686-4770
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Provider Business Mailing Address
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Address Line | 201 BAKER BLVD
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City | LELAND
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State | MS
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Zip | 38756-3401
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Country | US
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Telephone | 662-686-4121
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Fax | 662-686-4770
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 63470
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License Number State | CA
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