Provider Demographics
NPI:1982864898
Name:AGARWAL, RAVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:
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:PO BOX 418498
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8498
Mailing Address - Country:US
Mailing Address - Phone:703-558-1456
Mailing Address - Fax:703-558-1445
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:GA144
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-5380
Practice Address - Fax:202-877-5381
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10010951223S0112X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice