Provider Demographics
NPI:1962149328
Name:KAKKAR, MAYANK (BDS, MHA)
Entity type:Individual
Prefix:
First Name:MAYANK
Middle Name:
Last Name:KAKKAR
Suffix:
Gender:M
Credentials:BDS, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 MILLER SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3675
Mailing Address - Country:US
Mailing Address - Phone:832-577-6869
Mailing Address - Fax:
Practice Address - Street 1:6268 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3219
Practice Address - Country:US
Practice Address - Phone:440-684-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH30.026931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program