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General NPI Number Information
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NPI Number | 1720801798
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Entity Type | Organization
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Legal Business Name | PRERNA GARG DDS INC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 3845 LA SIERRA AVE STE 101B
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City | RIVERSIDE
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State | CA
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Zip | 92505-3594
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Country | US
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Telephone | 857-265-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 90 VANTIS DR UNIT 1122
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City | ALISO VIEJO
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State | CA
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Zip | 92656-2506
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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 | CEO
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Name | PRERNA GARG
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Credential |
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Telephone | 857-265-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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