Provider Demographics
NPI:1164158283
Name:AGARWAL, RUCHIKA (DDS, BDS)
Entity Type:Individual
Prefix:
First Name:RUCHIKA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:DDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 OLD SALEM RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5944
Mailing Address - Country:US
Mailing Address - Phone:678-756-3576
Mailing Address - Fax:
Practice Address - Street 1:1152 OLD SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5944
Practice Address - Country:US
Practice Address - Phone:678-756-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1227831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice