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General NPI Number Information
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NPI Number | 1861187346
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Entity Type | Individual
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Provider Name | SAMIRA MUKKAMALA DMD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2119 CLEARWATER DR
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City | OAK BROOK
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State | IL
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Zip | 60523-8821
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Country | US
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Telephone | 630-990-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 28294 FERRY RD APT 271
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City | WARRENVILLE
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State | IL
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Zip | 60555-4065
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Country | US
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Telephone | 334-294-2241
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019035526
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License Number State | IL
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