Provider Demographics
NPI:1730386947
Name:PRASOL, VICTORIA (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:PRASOL
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 1:10445 LARWIN AVE
Mailing Address - Street 2:4
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-7104
Mailing Address - Country:US
Mailing Address - Phone:818-718-2967
Mailing Address - Fax:
Practice Address - Street 1:26893 BOUQUET CANYON RD
Practice Address - Street 2:G
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2374
Practice Address - Country:US
Practice Address - Phone:661-297-7580
Practice Address - Fax:661-297-5298
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice