Provider Demographics
NPI:1033464607
Name:BARBAGALLO, AGNES (DDS)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:BARBAGALLO
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 1:5 HATFIELD LN STE 3
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6756
Mailing Address - Country:US
Mailing Address - Phone:845-360-5883
Mailing Address - Fax:
Practice Address - Street 1:5 HATFIELD LN STE 3
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6756
Practice Address - Country:US
Practice Address - Phone:845-360-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN196701223P0221X
NJ22DI025202001223P0221X
NY0564551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry