Provider Demographics
NPI:1629375506
Name:HANWATKAR, PRACHI (DDS MPH)
Entity Type:Individual
Prefix:
First Name:PRACHI
Middle Name:
Last Name:HANWATKAR
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-922-4000
Mailing Address - Fax:585-276-0293
Practice Address - Street 1:1425 PORTLAND AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-4282
Practice Address - Fax:585-276-0293
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0583451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program