Individual
DR. SASANKOTI MOHAN RAVI PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
PO BOX 209, MORA, NM 87732-0209
(505) 429-3999
Mailing address
PO BOX 209, MORA, NM 87732-0209
(505) 429-3999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2022020817
MO
122300000X
Dentist
Primary
DB-2025-0027
NM
1223G0001X
General Practice Dentistry
Primary
10463
SC
Other
Enumeration date
06/10/2022
Last updated
07/28/2026
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