Provider Demographics
NPI:1780886135
Name:AGBOR, EDITH N (BS)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:N
Last Name:AGBOR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 AMBERTON PKWY
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3278
Mailing Address - Country:US
Mailing Address - Phone:972-331-9120
Mailing Address - Fax:972-331-9121
Practice Address - Street 1:9330 AMBERTON PKWY
Practice Address - Street 2:SUITE 1135
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3278
Practice Address - Country:US
Practice Address - Phone:972-331-9120
Practice Address - Fax:972-331-9121
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12523069172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver