1437229390 NPI number — DR. SADHANA PRASAD DMD

Table of content: DR. SADHANA PRASAD DMD (NPI 1437229390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437229390 NPI number — DR. SADHANA PRASAD DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRASAD
Provider First Name:
SADHANA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437229390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 PINE MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH YARMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04097-6928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-846-0842
Provider Business Mailing Address Fax Number:
207-846-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 FOREST FALLS DR
Provider Second Line Business Practice Location Address:
UNIT 5
Provider Business Practice Location Address City Name:
YARMOUTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04096-6936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-846-8008
Provider Business Practice Location Address Fax Number:
207-846-8030
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  3331 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3331 . This is a "STATE DENTAL LICENSE NUMB" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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