Provider Demographics
NPI:1043103443
Name:PRINCELY, EVA PRASANTH
Entity type:Individual
Prefix:MRS
First Name:EVA
Middle Name:PRASANTH
Last Name:PRINCELY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EVA
Other - Middle Name:REENA
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:PSC 455 BOX 208
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540-0003
Mailing Address - Country:US
Mailing Address - Phone:671-797-8009
Mailing Address - Fax:
Practice Address - Street 1:PSC 455 BOX 208
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96540-0003
Practice Address - Country:US
Practice Address - Phone:671-797-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24171124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist