Provider Demographics
NPI:1245452788
Name:SUTHAR, PRAGNA HEMANT (DDS)
Entity type:Individual
Prefix:DR
First Name:PRAGNA
Middle Name:HEMANT
Last Name:SUTHAR
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 1:8929 S. MEMORIAL DRIVE
Mailing Address - Street 2:SUITE # 290
Mailing Address - City:TULSA
Mailing Address - State:MD
Mailing Address - Zip Code:74133-4947
Mailing Address - Country:US
Mailing Address - Phone:918-254-0135
Mailing Address - Fax:918-254-5116
Practice Address - Street 1:8929 S. MEMORIAL DRIVE
Practice Address - Street 2:SUITE # 290
Practice Address - City:TULSA
Practice Address - State:MD
Practice Address - Zip Code:74133-4947
Practice Address - Country:US
Practice Address - Phone:918-254-0135
Practice Address - Fax:918-254-5116
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice