Provider Demographics
NPI:1790934602
Name:AGOLLI, ADELA (DMD)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:
Last Name:AGOLLI
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 1:44 PRINCE ST
Mailing Address - Street 2:APT 510
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-1842
Mailing Address - Country:US
Mailing Address - Phone:617-638-4670
Mailing Address - Fax:
Practice Address - Street 1:44 PRINCE STREET
Practice Address - Street 2:APT 510
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113
Practice Address - Country:US
Practice Address - Phone:617-638-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist