Provider Demographics
NPI:1730312455
Name:VED PRAKASH, RAHUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:VED PRAKASH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 BROOK FOREST AVE
Mailing Address - Street 2:TROY DENTAL
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-8807
Mailing Address - Country:US
Mailing Address - Phone:515-664-5357
Mailing Address - Fax:
Practice Address - Street 1:964 BROOK FOREST AVE
Practice Address - Street 2:TROY DENTAL
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-8807
Practice Address - Country:US
Practice Address - Phone:515-664-5357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58773122300000X
IL019028741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist