Provider Demographics
NPI:1164719837
Name:SOJITRA, PRAKASH (DDS)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:SOJITRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 ACCLAIM WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1884
Mailing Address - Country:US
Mailing Address - Phone:510-456-6131
Mailing Address - Fax:
Practice Address - Street 1:4232 ACCLAIM WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1884
Practice Address - Country:US
Practice Address - Phone:510-456-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice