Provider Demographics
NPI:1619383098
Name:MATHUR, PRERNA
Entity Type:Individual
Prefix:DR
First Name:PRERNA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 ALMEDA RD
Mailing Address - Street 2:APT #1215
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2175
Mailing Address - Country:US
Mailing Address - Phone:405-905-1370
Mailing Address - Fax:
Practice Address - Street 1:7009 ALMEDA RD
Practice Address - Street 2:APT #1215
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2175
Practice Address - Country:US
Practice Address - Phone:405-905-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist