Provider Demographics
NPI:1821102252
Name:AGARWAL, HARI OM (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:OM
Last Name:AGARWAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4309
Mailing Address - Country:US
Mailing Address - Phone:718-515-3315
Mailing Address - Fax:718-515-3315
Practice Address - Street 1:4039 BARNES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4309
Practice Address - Country:US
Practice Address - Phone:718-515-3315
Practice Address - Fax:718-515-3315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01101519Medicaid