Provider Demographics
NPI:1487642302
Name:AGARWAL, DEEPAK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
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 1:1163 E OGDEN AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8532
Mailing Address - Country:US
Mailing Address - Phone:630-416-0780
Mailing Address - Fax:630-416-6938
Practice Address - Street 1:1163 E OGDEN AVE STE 403
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8532
Practice Address - Country:US
Practice Address - Phone:630-416-0780
Practice Address - Fax:630-416-6938
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0257711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL201725665-60563-01Medicaid