Individual
SRUTHI SASI PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2459 W JONATHAN MOORE PIKE, COLUMBUS, IN 47201-9206
(812) 516-5777
Mailing address
5301 WILLIAMSBURG STATION LN APT 106, JAMESTOWN, NC 27282-7819
(440) 753-1116
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
13254
NC
1223G0001X
General Practice Dentistry
Primary
12014264A
IN
Other
Enumeration date
06/05/2023
Last updated
11/27/2023
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