Healthcare Provider Details

I. General information

NPI: 1497689731
Provider Name (Legal Business Name): PRIYANKA PUGAZHENTHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 BOILING SPRINGS RD
BOILING SPRINGS SC
29316-5302
US

IV. Provider business mailing address

905 FRESH POND DR APT 6-307
WELLFORD SC
29385-8327
US

V. Phone/Fax

Practice location:
  • Phone: 864-661-6454
  • Fax:
Mailing address:
  • Phone: 864-661-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.11492.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: