Provider Demographics
NPI:1316256811
Name:ADHIKARI, PRABIDHI (DDS)
Entity type:Individual
Prefix:DR
First Name:PRABIDHI
Middle Name:
Last Name:ADHIKARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 ADMIRALTY WAY
Mailing Address - Street 2:#131
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6257
Mailing Address - Country:US
Mailing Address - Phone:480-228-0205
Mailing Address - Fax:
Practice Address - Street 1:4170 ADMIRALTY WAY
Practice Address - Street 2:#131
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6257
Practice Address - Country:US
Practice Address - Phone:480-228-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist