Provider Demographics
NPI:1184824922
Name:SIVAPRAKASAM, PRATHIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRATHIP
Middle Name:
Last Name:SIVAPRAKASAM
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 1:2857 IRONTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3214
Mailing Address - Country:US
Mailing Address - Phone:916-342-2574
Mailing Address - Fax:
Practice Address - Street 1:2223 S MONACO PKWY STE F
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5893
Practice Address - Country:US
Practice Address - Phone:303-639-3279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559031223G0001X
CODEN-000105041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice