Provider Demographics
NPI:1194445825
Name:KANIKANTI, RAGINI (DDS)
Entity type:Individual
Prefix:
First Name:RAGINI
Middle Name:
Last Name:KANIKANTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HIGH PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2394
Mailing Address - Country:US
Mailing Address - Phone:913-689-5051
Mailing Address - Fax:
Practice Address - Street 1:206 NE 7TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-5214
Practice Address - Country:US
Practice Address - Phone:913-689-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice