Provider Demographics
NPI:1316938004
Name:DEV, V PRABU (DDS)
Entity type:Individual
Prefix:DR
First Name:V
Middle Name:PRABU
Last Name:DEV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PRABHUSHAMAPPA
Other - Middle Name:
Other - Last Name:VEERASETTAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3800 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5028
Mailing Address - Country:US
Mailing Address - Phone:610-923-0100
Mailing Address - Fax:610-923-0115
Practice Address - Street 1:3800 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5028
Practice Address - Country:US
Practice Address - Phone:610-923-0100
Practice Address - Fax:610-923-0115
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020617Y122300000X
CA51753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000521830002Medicaid