Healthcare Provider Details

I. General information

NPI: 1184084683
Provider Name (Legal Business Name): AMITA AGARWAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

IV. Provider business mailing address

1601 WASHINGTON STREET
BOSTON MA
02118-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2000
  • Fax: 617-425-2002
Mailing address:
  • Phone: 617-425-2000
  • Fax: 617-425-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03313
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: