Healthcare Provider Details

I. General information

NPI: 1295649077
Provider Name (Legal Business Name): POOJA JAYANTIBHAI KATIRA BDS, MDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 ORANGE AVE APT 221
REDLANDS CA
92373-5317
US

IV. Provider business mailing address

1600 ORANGE AVE APT 221
REDLANDS CA
92373-5317
US

V. Phone/Fax

Practice location:
  • Phone: 857-400-1172
  • Fax:
Mailing address:
  • Phone: 857-400-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDENT.DE.70164165
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: