MEDICARE: DR. LAXMI PRANATI AKILLA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	61900	KS
2	1223G0001X	General Practice Dentistry	30.027713	OH

General Provider Information

NPI Number	:	1235708280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAXMI PRANATI AKILLA DDS

Provider Business Mailing Address
First Line	:	230 BLACKBERRY LN N
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-7190
Country	:	US
Telephone Number	:	313-603-7520
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 E NORTH ST
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-4027
Country	:	US
Telephone Number	:	614-885-7714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	01/06/2025

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