MEDICARE: BHAVANA AGADI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	21468	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316095631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHAVANA AGADI DMD

Provider Business Mailing Address
First Line	:	147 FISHER ST
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545
Country	:	US
Telephone Number	:	617-694-2371
Fax Number	:

Provider Business Practice Location Address
First Line	:	DENTAL SMILES CENTER, 1241 MAIN ST
Second Line	:	UNIT #8
City	:	WORCESTER
State	:	MA
Zip	:	01603
Country	:	US
Telephone Number	:	508-797-5555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	03/18/2016

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