Provider Demographics
NPI:1477372910
Name:AGRAWAL ENDODONTICS PLLC
Entity type:Organization
Organization Name:AGRAWAL ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH, CAGS
Authorized Official - Phone:617-816-0261
Mailing Address - Street 1:12651 W SUNRISE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-0906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12651 W SUNRISE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-0906
Practice Address - Country:US
Practice Address - Phone:617-816-0261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty