Provider Demographics
NPI:1518084433
Name:TAILOR, PRAKASHCHANDRA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRAKASHCHANDRA
Middle Name:M
Last Name:TAILOR
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 1:411 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4154
Mailing Address - Country:US
Mailing Address - Phone:407-933-0800
Mailing Address - Fax:
Practice Address - Street 1:411 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4154
Practice Address - Country:US
Practice Address - Phone:407-933-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11379122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist