Provider Demographics
NPI:1114569837
Name:AGARWAL, KOPAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KOPAL
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KOPAL
Other - Middle Name:
Other - Last Name:MITTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:21525 RIDGETOP CIR STE 220
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6577
Mailing Address - Country:US
Mailing Address - Phone:703-450-5302
Mailing Address - Fax:
Practice Address - Street 1:21525 RIDGETOP CIR STE 220
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6577
Practice Address - Country:US
Practice Address - Phone:703-450-5302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist