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Individual
DIVAKAR PRAKASH
Active
Individual
DIVAKAR PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
102866
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102866
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
08/07/2018
Last updated
08/07/2018
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