Provider Demographics
NPI:1447352224
Name:RAI, SHIVAPRASANNA (DDS)
Entity type:Individual
Prefix:
First Name:SHIVAPRASANNA
Middle Name:
Last Name:RAI
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 1:239 GARRISONVILLE RD
Mailing Address - Street 2:102
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1554
Mailing Address - Country:US
Mailing Address - Phone:540-657-0867
Mailing Address - Fax:
Practice Address - Street 1:239 GARRISONVILLE RD
Practice Address - Street 2:102
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1554
Practice Address - Country:US
Practice Address - Phone:540-657-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice