Provider Demographics
NPI:1720256811
Name:HALADY, PRATIMA GURUNATH (DMD)
Entity Type:Individual
Prefix:MRS
First Name:PRATIMA
Middle Name:GURUNATH
Last Name:HALADY
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 1:7301 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3726
Mailing Address - Country:US
Mailing Address - Phone:904-743-3114
Mailing Address - Fax:904-743-0788
Practice Address - Street 1:7301 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3726
Practice Address - Country:US
Practice Address - Phone:904-743-3114
Practice Address - Fax:904-743-0788
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL157701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice