Provider Demographics
NPI:1679634349
Name:AGOGLIA, KATHLEEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:L
Last Name:AGOGLIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6604
Mailing Address - Country:US
Mailing Address - Phone:917-613-8491
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:BROOKDALE HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0412951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice