Provider Demographics
NPI:1093902330
Name:PRAGASAM, JAMIE LETITIA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LETITIA
Last Name:PRAGASAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LETITIA
Other - Last Name:PRAGASAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DD
Mailing Address - Street 1:26630 BARTON RD
Mailing Address - Street 2:APT #1724
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:951-500-7171
Mailing Address - Fax:909-335-2225
Practice Address - Street 1:2048 ORANGE TREE LANE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-793-3443
Practice Address - Fax:909-335-2225
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice