Provider Demographics
NPI:1134468564
Name:PRASAD VASAMSETTI DMD, PLLC
Entity Type:Organization
Organization Name:PRASAD VASAMSETTI DMD, PLLC
Other - Org Name:BRIER CREEK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:VEERA
Authorized Official - Last Name:VASAMSETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-354-5400
Mailing Address - Street 1:7841 ALEXANDER PROMENADE PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-1913
Mailing Address - Country:US
Mailing Address - Phone:919-354-5400
Mailing Address - Fax:919-354-5401
Practice Address - Street 1:7841 ALEXANDER PROMENADE PL
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-1913
Practice Address - Country:US
Practice Address - Phone:919-354-5400
Practice Address - Fax:919-354-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59066141223D0001X
204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906614Medicaid
NC002746701OtherUNITED CONCORDIA