Provider Demographics
NPI:1639207749
Name:VASAMSETTI, PRASAD VEERA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:VEERA
Last Name:VASAMSETTI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7841 ALEXANDER PROMENADE PL SUITE 100
Mailing Address - Street 2:UNIT #225
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-354-5400
Mailing Address - Fax:
Practice Address - Street 1:7841 ALEXANDER PROMENADE PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:601-918-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906614Medicaid