Provider Demographics
NPI:1881766988
Name:PRASAD, JOSEPH PHILLIP (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILLIP
Last Name:PRASAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 MORRIS AVE
Mailing Address - Street 2:SUITE B4
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3531
Mailing Address - Country:US
Mailing Address - Phone:908-686-0302
Mailing Address - Fax:908-686-0325
Practice Address - Street 1:1961 MORRIS AVE
Practice Address - Street 2:SUITE B4
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3531
Practice Address - Country:US
Practice Address - Phone:908-686-0302
Practice Address - Fax:908-686-0325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI013595-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5088101Medicaid