Provider Demographics
NPI:1407370018
Name:PRAKASH DENTISTRY, LLC
Entity Type:Organization
Organization Name:PRAKASH DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGASHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-582-2611
Mailing Address - Street 1:2136 LAS BRISAS CIR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8952
Mailing Address - Country:US
Mailing Address - Phone:408-582-2611
Mailing Address - Fax:
Practice Address - Street 1:3111 EUBANK BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4875
Practice Address - Country:US
Practice Address - Phone:505-296-5458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty