MEDICARE: DR. DON LEWIS PRASNIKAR DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D5552	OR
2	1223G0001X	General Practice Dentistry	DE00004786	WA

General Provider Information

NPI Number	:	1699883215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DON LEWIS PRASNIKAR DDS

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	503-813-4970
Fax Number	:	503-813-3103

Provider Business Practice Location Address
First Line	:	500 NE MULTNOMAH ST
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2099
Country	:	US
Telephone Number	:	503-813-4970
Fax Number	:	503-813-3103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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