Provider Demographics
NPI:1700986403
Name:PRAKASH, NIDHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:NIDHI
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BALTIC CIR
Mailing Address - Street 2:UNIT 525
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-2261
Mailing Address - Country:US
Mailing Address - Phone:650-200-9996
Mailing Address - Fax:
Practice Address - Street 1:371 JACKLIN RD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3225
Practice Address - Country:US
Practice Address - Phone:408-263-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA543031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice