Provider Demographics
NPI:1831219443
Name:PRASAD, LES R (DDS)
Entity type:Individual
Prefix:DR
First Name:LES
Middle Name:R
Last Name:PRASAD
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 1:8 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4526
Mailing Address - Country:US
Mailing Address - Phone:401-728-8924
Mailing Address - Fax:401-228-7188
Practice Address - Street 1:989 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5138
Practice Address - Country:US
Practice Address - Phone:401-944-7556
Practice Address - Fax:401-228-7188
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist