Healthcare Provider Details

I. General information

NPI: 1457726523
Provider Name (Legal Business Name): PRAGYA GOEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4817 SAN DARIO AVE
LAREDO TX
78041
US

IV. Provider business mailing address

4817 SAN DARIO AVE
LAREDO TX
78041-5754
US

V. Phone/Fax

Practice location:
  • Phone: 804-253-1992
  • Fax:
Mailing address:
  • Phone: 956-728-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number31384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: