Provider Demographics
NPI:1346725843
Name:AGARWAL, SHOBHIT (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHIT
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W SQUANTUM ST APT 1104
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2111
Mailing Address - Country:US
Mailing Address - Phone:186-221-5165
Mailing Address - Fax:
Practice Address - Street 1:165 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1821
Practice Address - Country:US
Practice Address - Phone:508-841-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist