Provider Demographics
NPI:1558440743
Name:AGARWAL, ANITA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 87TH ST
Mailing Address - Street 2:APT. 10E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7665
Mailing Address - Country:US
Mailing Address - Phone:603-440-8421
Mailing Address - Fax:646-536-3150
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:ROOM 3C15
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-3060
Practice Address - Fax:718-918-4469
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0524461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02730156Medicaid