Healthcare Provider Details

I. General information

NPI: 1871486589
Provider Name (Legal Business Name): KEVIN PRASHAD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LOGANVILLE HWY STE 100
BETHLEHEM GA
30620-2164
US

IV. Provider business mailing address

3189 HIGHWAY 78
LOGANVILLE GA
30052-3743
US

V. Phone/Fax

Practice location:
  • Phone: 706-447-9903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number123927
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: