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General NPI Number Information
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NPI Number | 1093902330
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Entity Type | Individual
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Provider Name | JAMIE LETITIA PRAGASAM DDS
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Gender | Female
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 2048 ORANGE TREE LANE
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City | REDLANDS
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State | CA
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Zip | 92374
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Country | US
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Telephone | 909-793-3443
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Fax | 909-335-2225
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Provider Business Mailing Address
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Address Line | 26630 BARTON RD APT #1724
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 951-500-7171
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Fax | 909-335-2225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56187
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License Number State | CA
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