Provider Demographics
NPI:1669457628
Name:PRASAD, LISA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:PRASAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LOGAN FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9747
Mailing Address - Country:US
Mailing Address - Phone:724-733-8009
Mailing Address - Fax:
Practice Address - Street 1:5109 STATE ROUTE 30
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7750
Practice Address - Country:US
Practice Address - Phone:724-850-7888
Practice Address - Fax:724-850-7775
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0358581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice