Provider Demographics
NPI:1831733211
Name:MUDITA AGRAWAL DDS INC
Entity type:Organization
Organization Name:MUDITA AGRAWAL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-647-1795
Mailing Address - Street 1:3752 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-4418
Mailing Address - Country:US
Mailing Address - Phone:650-780-9429
Mailing Address - Fax:650-780-9451
Practice Address - Street 1:3752 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-4418
Practice Address - Country:US
Practice Address - Phone:650-780-9429
Practice Address - Fax:650-780-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental