Provider Demographics
NPI:1114631272
Name:PRASANTHI CHILDREN'S DENTISTRY,LLC
Entity Type:Organization
Organization Name:PRASANTHI CHILDREN'S DENTISTRY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVULA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-254-1435
Mailing Address - Street 1:100 HARBORVIEW DRIVE
Mailing Address - Street 2:UNIT 1104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230
Mailing Address - Country:US
Mailing Address - Phone:443-254-1435
Mailing Address - Fax:
Practice Address - Street 1:100 HARBORVIEW DRIVE
Practice Address - Street 2:UNIT 1104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230
Practice Address - Country:US
Practice Address - Phone:443-254-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty