# SIVA PRAKASH KOLLA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1932376779
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE60606397 | WA | Yes |

## Other

- **Enumeration date:** 05/12/2008
- **Last updated:** 07/17/2023