Provider Demographics
NPI:1043281587
Name:PRASAD, KRISHNASWAMY SATYA (DDS)
Entity type:Individual
Prefix:
First Name:KRISHNASWAMY
Middle Name:SATYA
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 1:11610 E SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3340
Mailing Address - Country:US
Mailing Address - Phone:562-692-1330
Mailing Address - Fax:562-692-1335
Practice Address - Street 1:11610 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3340
Practice Address - Country:US
Practice Address - Phone:562-692-1330
Practice Address - Fax:562-692-1335
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2791601OtherDENTICAL