Provider Demographics
NPI:1538701230
Name:SULEKHA AGRAWAL DMD LLC
Entity Type:Organization
Organization Name:SULEKHA AGRAWAL DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SULEKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-319-3491
Mailing Address - Street 1:11145 MARTHA WAY
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2214
Mailing Address - Country:US
Mailing Address - Phone:410-730-0011
Mailing Address - Fax:
Practice Address - Street 1:9194 RED BRANCH RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2005
Practice Address - Country:US
Practice Address - Phone:410-730-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty