Individual
DR. PRASHANTH KONATHAM HARIBABU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, BDS, MDS, MSD
Contact information
Practice address
1500 PARK AVE, ORAL MAXILLOFACIAL SURGERY, ST LOUIS, MO 63104-3024
(146) 853-5793
(314) 588-8437
Mailing address
1500 PARK AVE, SAINT LOUIS, MO 63104-3024
(314) 833-2723
(314) 588-8437
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2018032931
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2901021748
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14339940
—
MO
Enumeration date
04/25/2014
Last updated
10/03/2019
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