Provider Demographics
NPI:1205006509
Name:AGNIHOTRI, NEIL (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:AGNIHOTRI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545A NUCKOLS ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5666
Mailing Address - Country:US
Mailing Address - Phone:804-673-8061
Mailing Address - Fax:804-673-5644
Practice Address - Street 1:7702 PARHAM ROAD SUITE 120
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4366
Practice Address - Country:US
Practice Address - Phone:804-270-5028
Practice Address - Fax:804-747-3599
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02234700122300000X
VA04014127431223S0112X
VA0101247300204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery