Healthcare Provider Details

I. General information

NPI: 1154656346
Provider Name (Legal Business Name): AKASH D AGRAWAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 WOOSTER DR
BRYANS ROAD MD
20616-3023
US

IV. Provider business mailing address

3165 WOOSTER DR
BRYANS ROAD MD
20616-3023
US

V. Phone/Fax

Practice location:
  • Phone: 301-283-6211
  • Fax:
Mailing address:
  • Phone: 301-283-6211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: