Provider Demographics
NPI:1093901647
Name:RAO, PRASHANT RAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:RAVI
Last Name:RAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:202 E WOODLAWN RD
Mailing Address - Street 2:STE 114
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2213
Mailing Address - Country:US
Mailing Address - Phone:704-522-1550
Mailing Address - Fax:704-522-1558
Practice Address - Street 1:6708 ALBERMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212
Practice Address - Country:US
Practice Address - Phone:704-537-1990
Practice Address - Fax:704-531-2757
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8322OtherLICENSE
NC8322OtherLICENSE