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General NPI Number Information
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NPI Number | 1790400646
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Entity Type | Individual
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Provider Name | PRASHANTHINI NIVETHAN DDS
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Gender | Female
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 3200 MOWRY AVE
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City | FREMONT
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State | CA
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Zip | 94538-1510
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Country | US
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Telephone | 510-796-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 WALNUT AVE APT 3422
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City | FREMONT
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State | CA
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Zip | 94536-4575
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Country | US
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Telephone | 212-498-9658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 108049
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License Number State | CA
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