# SRUTHI SASI PRAKASH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1306530415
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 13254 | NC | — |
| 1223G0001X | General Practice Dentistry | 12014264A | IN | Yes |

## Other

- **Enumeration date:** 06/05/2023
- **Last updated:** 11/27/2023