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General NPI Number Information
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NPI Number | 1942372651
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Entity Type | Organization
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Legal Business Name | LLOYD ALFRED PRAGASAM
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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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 | 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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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. LLOYD ALFRED PRAGASAM
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Credential | DDS
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Telephone | 909-793-3443
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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 | 26219
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License Number State | CA
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