Provider Demographics
NPI:1245769454
Name:PRASAD, RAJASHREE (DMD)
Entity Type:Individual
Prefix:
First Name:RAJASHREE
Middle Name:
Last Name:PRASAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SEMINOLE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7220
Mailing Address - Country:US
Mailing Address - Phone:408-507-1287
Mailing Address - Fax:
Practice Address - Street 1:9222 W PARMER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4676
Practice Address - Country:US
Practice Address - Phone:512-363-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist