Provider Demographics
NPI:1568909943
Name:AGRAWAL, PRATIKSHA (BDS, MSC)
Entity Type:Individual
Prefix:
First Name:PRATIKSHA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:BDS, MSC
Other - Prefix:
Other - First Name:PRATIKSHA
Other - Middle Name:RAJENDRAPRASAD
Other - Last Name:BHALOTIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:933 PLANETREE PL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8650
Mailing Address - Country:US
Mailing Address - Phone:312-208-5566
Mailing Address - Fax:
Practice Address - Street 1:704 BLOSSOM HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5403
Practice Address - Country:US
Practice Address - Phone:408-363-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022098122300000X
WADE60631437122300000X
VA0401415375122300000X
IN12013080A122300000X
IL019031038122300000X
CACA105767122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist