Provider Demographics
NPI:1629616081
Name:PERSAD, ESHA (DDS)
Entity Type:Individual
Prefix:MS
First Name:ESHA
Middle Name:
Last Name:PERSAD
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 1:110 CRESCENT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-2119
Mailing Address - Country:US
Mailing Address - Phone:720-725-7954
Mailing Address - Fax:
Practice Address - Street 1:303 ASHBY PARK LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6903
Practice Address - Country:US
Practice Address - Phone:864-987-5578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95551223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice