Provider Demographics
NPI:1043430861
Name:DEORE, PRACHI (DDS)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:
Last Name:DEORE
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 1:760 NORTH DENTON TAP ROAD
Mailing Address - Street 2:STE 190
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-315-2200
Mailing Address - Fax:972-534-1223
Practice Address - Street 1:760 NORTH DENTON TAP ROAD
Practice Address - Street 2:STE 190
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-315-2200
Practice Address - Fax:972-534-1223
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22955122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist