Provider Demographics
NPI:1497904957
Name:BARA, AGNIESZKA (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:AGNIESZKA
Middle Name:
Last Name:BARA
Suffix:
Gender:F
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1930
Mailing Address - Country:US
Mailing Address - Phone:732-537-9922
Mailing Address - Fax:732-537-9920
Practice Address - Street 1:476 UNION AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1930
Practice Address - Country:US
Practice Address - Phone:732-537-9922
Practice Address - Fax:732-537-9920
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02157200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist