Provider Demographics
NPI:1982044855
Name:GAJERA, PRASHANTKUMAR CHHAGANLAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRASHANTKUMAR
Middle Name:CHHAGANLAL
Last Name:GAJERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 LASSEN LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-1248
Mailing Address - Country:US
Mailing Address - Phone:201-665-5553
Mailing Address - Fax:
Practice Address - Street 1:3030 LBJ FWY
Practice Address - Street 2:SUITE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7781
Practice Address - Country:US
Practice Address - Phone:972-488-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist