Provider Demographics
NPI:1972649762
Name:PRADHAN, VAIBHAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAIBHAVI
Middle Name:
Last Name:PRADHAN
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 1:3950 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3026
Mailing Address - Country:US
Mailing Address - Phone:718-652-6622
Mailing Address - Fax:845-406-4751
Practice Address - Street 1:3950 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3026
Practice Address - Country:US
Practice Address - Phone:718-652-6622
Practice Address - Fax:845-406-4751
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY334Medicaid