Prashanth Konatham Haribabu, DDS, BDS, MDS, MSD

Primary specialty

DentistTaxonomy code 122300000X

License

2018032931 Issued in MO

Practice address

1500 Park Ave
Oral Maxillofacial Surgery
St Louis, MO 63104-3024

Phone

(146) 853-5793

Fax

(314) 588-8437

NPI assigned

Apr 25, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: prashanth.haribabu.p1@direct.affiniahealthcare.nextgenshare.com

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

• Cignodental Care LLP

  • General Practice Dentistry
  • Saint Louis, MO
  • NPI 1447536453
  NPD (past)

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1811317142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 PARK AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631043024",
            "telephone_number": "314-833-2723",
            "fax_number": "314-588-8437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PARK AVE",
            "address_2": "ORAL MAXILLOFACIAL SURGERY",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "631043024",
            "telephone_number": "146-853-5793",
            "fax_number": "314-588-8437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12000 Bellefontaine Rd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631381903",
            "country_code": "US",
            "telephone_number": "314-741-5133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KONATHAM HARIBABU",
        "first_name": "PRASHANTH",
        "name_prefix": "Dr.",
        "credential": "DDS, BDS, MDS, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-25",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901021748",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "2018032931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14339940",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Keith Komorowski, LCSW
• Lauren Ashley Komorowski
• Lauren Komp, LCSW
• Kevin Kon, PHARMD
• Sivasankara R Konala, MD
• Yamuna Reddy Kondapally, MD
• Jamie Lynn Kondis, MD
• Andrew Paul Kong, MD
• Daniel Kong
• Deborah Konkol, M.D.

• Dentist in St Louis, MO
• Providers in St Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.