Provider Demographics
NPI:1023183340
Name:BAGCHI, ADITI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADITI
Middle Name:
Last Name:BAGCHI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17043 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9555
Mailing Address - Country:US
Mailing Address - Phone:248-854-9617
Mailing Address - Fax:
Practice Address - Street 1:17043 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9555
Practice Address - Country:US
Practice Address - Phone:248-854-9617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist