Provider Demographics
NPI:1235230475
Name:PRASAD, ANUPAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANUPAM
Middle Name:
Last Name:PRASAD
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 1:250 MONTCLAIR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1761
Mailing Address - Country:US
Mailing Address - Phone:408-259-4663
Mailing Address - Fax:408-259-3402
Practice Address - Street 1:250 MONTCLAIR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1761
Practice Address - Country:US
Practice Address - Phone:408-259-4663
Practice Address - Fax:408-259-3402
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice