Provider Demographics
NPI:1063512333
Name:PRABHU, MAYA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAYA
Middle Name:
Last Name:PRABHU
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 1:19 BARNYARD CT
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3137
Mailing Address - Country:US
Mailing Address - Phone:732-246-2284
Mailing Address - Fax:732-246-2373
Practice Address - Street 1:76 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2520
Practice Address - Country:US
Practice Address - Phone:732-246-2284
Practice Address - Fax:732-246-2373
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI178881223E0200X
NY043598-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics