Provider Demographics
NPI:1679678676
Name:PRASAD, ROLLIN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROLLIN
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 STATE ROUTE 30
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-7750
Mailing Address - Country:US
Mailing Address - Phone:724-850-7888
Mailing Address - Fax:
Practice Address - Street 1:5109 STATE ROUTE 30
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7750
Practice Address - Country:US
Practice Address - Phone:724-850-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS035857122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist