Provider Demographics
NPI:1790433845
Name:PRAKASH, ANUSHKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANUSHKA
Middle Name:
Last Name:PRAKASH
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 1:333 MAIN ST UNIT 315
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4928
Mailing Address - Country:US
Mailing Address - Phone:917-674-6346
Mailing Address - Fax:
Practice Address - Street 1:36 PADANARAM RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4886
Practice Address - Country:US
Practice Address - Phone:203-748-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02911200122300000X
CT13939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist