Prashan Shanthakumar, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D011814 Issued in AZ

Practice address

13733 N Prasada Pkwy Ste 108
Surprise, AZ 85388-8014

Phone

(623) 777-3329

NPI assigned

May 18, 2019

Last updated

Aug 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Surprise Modern Dentistry LLP

  dba Surprise Modern Dentistry

  • General Practice Dentistry
  • Surprise, AZ
  • NPI 1376200261
  NPD

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

{
    "created_epoch": "1558137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1215593868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13733 N PRASADA PKWY STE 108",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853888014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13733 N PRASADA PKWY STE 108",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853888014",
            "telephone_number": "623-777-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANTHAKUMAR",
        "first_name": "PRASHAN",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-05-18",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "D011814",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Nicole Shafer, PT, DPT
• Dawn Shagena
• Masih Shahlaie, B.D.S., M.S.
• Aaron David Shamblin, OTR L
• Elizabeth Shamon, OTD, OTR/L
• Nandini Paul Sharma, M.D.
• Joelle Shavers
• Anne Shaw, NMD
• Joshua Joseph Shaw
• Jessica Shaylor

• Periodontics in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.