Provider Demographics
NPI:1457827859
Name:AGARWAL, CHETAN (DMD)
Entity Type:Individual
Prefix:
First Name:CHETAN
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 1:9810 ARDLEY PARK WAY
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0113
Mailing Address - Country:US
Mailing Address - Phone:314-695-1319
Mailing Address - Fax:
Practice Address - Street 1:8505 DAVIS LAKE PKWY STE AB3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3415
Practice Address - Country:US
Practice Address - Phone:980-434-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001958-151223G0001X
NC126041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice