MEDICARE: DURGA GSP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1982479317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURGA GSP, PLLC

Provider Business Mailing Address
First Line	:	16103 W LITTLE YORK RD STE O
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-6867
Country	:	US
Telephone Number	:	281-463-8603
Fax Number	:	281-858-0471

Provider Business Practice Location Address
First Line	:	16103 W LITTLE YORK RD STE O
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-6867
Country	:	US
Telephone Number	:	281-463-8603
Fax Number	:	281-858-0471

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. PRERNA MATHUR
Credential	:	DDS
Telephone Number	:	281-463-8603

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	01/30/2025

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