Individual
SREENIVAS KOKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Mailing address
201 BAKER BLVD, LELAND, MS 38756-3401
(662) 686-4121
(662) 686-4770
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
63470
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33828500
—
WI
05
—
587433500
—
MN
01
—
P00918769
RAILROAD MEDICARE
MN
Enumeration date
01/03/2006
Last updated
11/05/2024
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