Provider Demographics
NPI:1417333881
Name:MUKKA, SPANDANA (DDS)
Entity type:Individual
Prefix:DR
First Name:SPANDANA
Middle Name:
Last Name:MUKKA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 BRIER CREEK PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6519
Mailing Address - Country:US
Mailing Address - Phone:919-336-2981
Mailing Address - Fax:919-249-1375
Practice Address - Street 1:9400 BRIER CREEK PKWY STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6519
Practice Address - Country:US
Practice Address - Phone:919-336-2981
Practice Address - Fax:919-249-1375
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113771223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice