Individual
DIVAKAR PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2808 W MONTE VISTA AVE, TURLOCK, CA 95380-8409
(415) 316-5396
Mailing address
400 CLEMENTINA ST APT 408, SAN FRANCISCO, CA 94103-4254
(415) 316-5396
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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