Jai Krishna Srikanth Kolliboyana, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36098 Issued in TX

Practice address

4403 Sherwood Way
San Angelo, TX 76901-5616

Phone

(325) 308-6337

NPI assigned

Jul 28, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oak Creek Corporation

  • Dental Clinic/Center
  • Round Rock, TX
  • NPI 1417639766
  NPD
• Access Dental of Peoria Optim LLC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1437818242
  NPD (past)
• Optim Dental Peoria-1 LLC

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1962943290
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1194379271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 CROMWELL DR APT 3210",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406496",
            "telephone_number": "989-423-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 SHERWOOD WAY",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769015616",
            "telephone_number": "325-308-6337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Fm 518 Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Kemah",
            "state": "TX",
            "postal_code": "775653281",
            "country_code": "US",
            "telephone_number": "281-957-7488",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLLIBOYANA",
        "first_name": "JAI KRISHNA SRIKANTH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-28",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.032253",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Knickerbocker, LPC
• James Lee Knight, LCDC
• Ronald Lynn Knight, DDS MSD
• Kathleen Anne Koehn, OTR
• Kelly Lee Koenig, D.O.
• Sanaya Girish Kondaskar, MOT
• Seth Ramsey Koschak, DDS
• Anna Kosztowski, MD
• Ashok Kumar Koul, MD
• Jonathan Kouts, DO

• General Practice Dentistry in San Angelo, TX
• Providers in San Angelo, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.