Healthcare Provider Details

I. General information

NPI: 1134468564
Provider Name (Legal Business Name): PRASAD VASAMSETTI DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7841 ALEXANDER PROMENADE PL SUITE 100
RALEIGH NC
27617-1913
US

IV. Provider business mailing address

7841 ALEXANDER PROMENADE PL SUITE 100
RALEIGH NC
27617-1913
US

V. Phone/Fax

Practice location:
  • Phone: 919-354-5400
  • Fax: 919-354-5401
Mailing address:
  • Phone: 919-354-5400
  • Fax: 919-354-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5906614
License Number StateNC

VIII. Authorized Official

Name: DR. PRASAD VEERA VASAMSETTI
Title or Position: OWNER/ MANAGER
Credential: DMD
Phone: 919-354-5400