Provider Demographics
NPI:1851568182
Name:MICHAEL F AGNINI DDS
Entity Type:Organization
Organization Name:MICHAEL F AGNINI DDS
Other - Org Name:AGNINI FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:AGNINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:863-682-1500
Mailing Address - Street 1:2304 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2910
Mailing Address - Country:US
Mailing Address - Phone:863-682-1500
Mailing Address - Fax:863-682-6318
Practice Address - Street 1:2304 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2910
Practice Address - Country:US
Practice Address - Phone:863-682-1500
Practice Address - Fax:863-682-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN59641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty