Individual
DR. PRASHAN SHANTHAKUMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
13733 N PRASADA PKWY STE 108, SURPRISE, AZ 85388-8014
(623) 777-3329
Mailing address
13733 N PRASADA PKWY STE 108, SURPRISE, AZ 85388-8014
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D011814
AZ
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/18/2019
Last updated
08/17/2023
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