Provider Demographics
NPI:1326856105
Name:ANKITHA PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANKITHA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTHALA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWDARA SRINIVASA REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-227-0000
Mailing Address - Street 1:3718 PLATTE RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2696
Mailing Address - Country:US
Mailing Address - Phone:407-227-0000
Mailing Address - Fax:
Practice Address - Street 1:305 E ELDORADO PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5112
Practice Address - Country:US
Practice Address - Phone:407-227-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental