Provider Demographics
NPI:1548601917
Name:PRABHAKAR, SHWETA
Entity Type:Individual
Prefix:DR
First Name:SHWETA
Middle Name:
Last Name:PRABHAKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WEDEMEYER ST
Mailing Address - Street 2:UNIT 501
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94129-5274
Mailing Address - Country:US
Mailing Address - Phone:415-519-5117
Mailing Address - Fax:
Practice Address - Street 1:1801 WEDEMEYER ST
Practice Address - Street 2:UNIT 501
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-5274
Practice Address - Country:US
Practice Address - Phone:415-519-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62588122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA62588OtherDENTAL LISCENSE