Provider Demographics
NPI:1134615032
Name:AGRAWAL, PRIYANKA (DDS)
Entity type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LATITUDE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4939
Mailing Address - Country:US
Mailing Address - Phone:512-299-3806
Mailing Address - Fax:
Practice Address - Street 1:3650 W STAN SCHLUETER LOOP # 160
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6814
Practice Address - Country:US
Practice Address - Phone:254-699-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist