Provider Demographics
NPI:1013161298
Name:ALEGAONKAR, ARCHANA KAUSTUBH
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:KAUSTUBH
Last Name:ALEGAONKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ARCHANA
Other - Middle Name:
Other - Last Name:JOGLEKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 WESTERN AVE NW
Mailing Address - Street 2:SUITE A3A
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-4510
Mailing Address - Country:US
Mailing Address - Phone:507-333-2028
Mailing Address - Fax:507-333-2038
Practice Address - Street 1:200 WESTERN AVE NW
Practice Address - Street 2:SUITE A3A
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-4510
Practice Address - Country:US
Practice Address - Phone:507-333-2028
Practice Address - Fax:507-333-2038
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND123621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice