Provider Demographics
NPI:1639685621
Name:AGOKA DENTAL PLLC
Entity Type:Organization
Organization Name:AGOKA DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NARESH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS
Authorized Official - Phone:813-879-9000
Mailing Address - Street 1:3306 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2904
Mailing Address - Country:US
Mailing Address - Phone:813-879-9000
Mailing Address - Fax:
Practice Address - Street 1:3306 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2904
Practice Address - Country:US
Practice Address - Phone:813-879-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty