Individual
PRASHANSA GAUTAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
50 S HUNTINGTON AVE, BOSTON, MA 02130-4713
(617) 232-9500
Mailing address
22 COLLEGE DR, STONY BROOK, NY 11790-2724
(631) 624-5914
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/25/2024
Last updated
03/25/2024
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