Provider Demographics
NPI:1629348354
Name:PRASANNAKUMAR, PRIYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:
Last Name:PRASANNAKUMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CORALFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5529
Mailing Address - Country:US
Mailing Address - Phone:510-449-9513
Mailing Address - Fax:
Practice Address - Street 1:140 CORALFLOWER LN
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5529
Practice Address - Country:US
Practice Address - Phone:510-449-9513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60950122300000X
TX27728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist