Individual provider Active NPI

Prashanti Bollu, D.M.D., M.S., M.B.A.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Henderson, NV
National Provider Identifier
1083849178
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
S3-228 Issued in NV
Practice address
1450 W Horizon Ridge Pkwy Ste B308-309
Henderson, NV 89012-4477
Phone
(702) 703-0102
Fax
(702) 723-6773
NPI assigned
May 19, 2009
Last updated
Feb 27, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X S3-228 NV Primary

Addresses

Primary practice location

1450 W Horizon Ridge Pkwy Ste B308-309
Henderson, NV 89012-4477

Mailing address

771 Glowing Horizon St
Henderson, NV 89052-8743
Phone (617) 849-0751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Business Administration, Master of Science

State licenses

LicenseStateTypeSpecialty
S3-228NVMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
P&G Smiles LLC Orthodontics and Dentofacial Orthopedics PastSince Dec 27, 2020 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772150400000",
    "number": "1083849178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 GLOWING HORIZON ST",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890528743",
            "telephone_number": "617-849-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 W HORIZON RIDGE PKWY STE B308-309",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890124477",
            "telephone_number": "702-703-0102",
            "fax_number": "702-723-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLU",
        "first_name": "PRASHANTI",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S., M.B.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-19",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NV",
            "license": "S3-228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.