Provider Demographics
NPI:1730210659
Name:GAGNEJA, RAJESH KUMAR (DDS)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:KUMAR
Last Name:GAGNEJA
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 1:6313 EMERALD RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3493
Mailing Address - Country:US
Mailing Address - Phone:407-925-7692
Mailing Address - Fax:
Practice Address - Street 1:815 W HOLT BLVD
Practice Address - Street 2:#402
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3681
Practice Address - Country:US
Practice Address - Phone:909-635-0444
Practice Address - Fax:909-635-0448
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50112122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice