Provider Demographics
NPI:1700038908
Name:PRASAD, BHAWNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BHAWNA
Middle Name:
Last Name:PRASAD
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 1:5911 NORTHWEST HWY.
Mailing Address - Street 2:STE. 104 WINDSOR DENTAL, P.C.
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:815-479-0944
Mailing Address - Fax:815-479-5271
Practice Address - Street 1:5911 NORTHWEST HWY.
Practice Address - Street 2:STE. 104 WINDSOR DENTAL, P.C.
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-479-0944
Practice Address - Fax:815-479-5271
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190261291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice