Healthcare Provider Details

I. General information

NPI: 1356203756
Provider Name (Legal Business Name): PRAGYAN MOHANTY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E SCHOOL AVE
VISALIA CA
93291-5032
US

IV. Provider business mailing address

5 KENSINGTON LN UNIT 201
ROCKY HILL CT
06067-3635
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 602-596-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS112287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: