Rajsekhar Mukkamala, DDS
Individual provider Active NPI Dentist · Ellenton, FL
NPI 1336309152 · NPPES record last updated Jun 13, 2014
Key facts
- NPI
- 1336309152
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN18304 (FL)
- Practice address
- 3030 US Highway 301 N
Ellenton, FL 34222-2010 - Phone
- (941) 722-0502
- NPI assigned
- Jun 16, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN18304 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN18304 | FL | Yes |
Addresses
Primary practice location
3030 US Highway 301 N
Ellenton, FL 34222-2010
Mailing address
5760 Fossano Drive
Sarasota, FL 34238
Phone (941) 927-9070
Other providers in Ellenton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.