Provider Demographics
NPI:1831641810
Name:AGARWAL, ISHITA (DMD; MS)
Entity Type:Individual
Prefix:DR
First Name:ISHITA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:DMD; MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 10TH CT W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8528
Mailing Address - Country:US
Mailing Address - Phone:716-866-8660
Mailing Address - Fax:
Practice Address - Street 1:5010 GARTH RD STE 204
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2254
Practice Address - Country:US
Practice Address - Phone:281-394-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13764122300000X
TX35020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist