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General NPI Number Information
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NPI Number | 1033460183
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Entity Type | Organization
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Legal Business Name | GAGNEJA, BDS, PLLC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 601 SE 117TH AVE STE 150
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone | 360-772-9547
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Fax |
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Provider Business Mailing Address
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Address Line | 601 SE 117TH AVE STE 150
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL/CO-OWNER
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Name | DR. PRASHANT GAGNEJA
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Credential | BDS, MDS
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Telephone | 360-433-2997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE00010029
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License Number State | WA
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