Provider Demographics
NPI:1649358771
Name:THURAISAMY, PRAKASH (DDS)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:THURAISAMY
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 1:1007 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14904
Mailing Address - Country:US
Mailing Address - Phone:607-734-2045
Mailing Address - Fax:607-734-6103
Practice Address - Street 1:1007 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14904
Practice Address - Country:US
Practice Address - Phone:607-734-2045
Practice Address - Fax:607-734-6103
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist