Provider Demographics
NPI:1427758952
Name:ITTIRUCK, ANNIKA (DDS)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:ITTIRUCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SHORE DISTRICT DR APT 2224
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1329
Mailing Address - Country:US
Mailing Address - Phone:817-889-0112
Mailing Address - Fax:
Practice Address - Street 1:314 E HIGHLAND MALL BLVD STE 500
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3733
Practice Address - Country:US
Practice Address - Phone:512-452-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist