Provider Demographics
NPI:1841671666
Name:JAGLAL, RAJESH (DMD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:JAGLAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 TIMPANY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-5200
Mailing Address - Country:US
Mailing Address - Phone:954-279-6190
Mailing Address - Fax:
Practice Address - Street 1:3120 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2506
Practice Address - Country:US
Practice Address - Phone:361-887-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice