Provider Demographics
NPI:1700227923
Name:AGRAWAL, DHIREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DHIREN
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 CONSERVATION PL APT 105
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8747
Mailing Address - Country:US
Mailing Address - Phone:617-690-9919
Mailing Address - Fax:
Practice Address - Street 1:249 PALM BAY RD NE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-8602
Practice Address - Country:US
Practice Address - Phone:617-690-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist