Provider Demographics
NPI:1013129063
Name:AMITA AGGARWAL, DMD, LLC
Entity Type:Organization
Organization Name:AMITA AGGARWAL, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-342-3303
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1512
Mailing Address - Country:US
Mailing Address - Phone:860-342-3303
Mailing Address - Fax:860-342-1929
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1512
Practice Address - Country:US
Practice Address - Phone:860-342-3303
Practice Address - Fax:860-342-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty