Provider Demographics
NPI:1235275447
Name:PRAKASH, ARJUNAN JAI
Entity Type:Individual
Prefix:DR
First Name:ARJUNAN
Middle Name:JAI
Last Name:PRAKASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3939
Mailing Address - Country:US
Mailing Address - Phone:386-734-5352
Mailing Address - Fax:
Practice Address - Street 1:214 N SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3939
Practice Address - Country:US
Practice Address - Phone:386-734-5352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice