Healthcare Provider Details

I. General information

NPI: 1538361803
Provider Name (Legal Business Name): TARUN AGARWAL DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 CREEDMOOR ROAD
RALEIGH NC
27613-1697
US

IV. Provider business mailing address

8304 CREEDMOOR ROAD
RALEIGH NC
27613-1697
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-7645
  • Fax: 919-870-8931
Mailing address:
  • Phone: 919-870-7645
  • Fax: 919-870-8931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: TARUN AGARWAL
Title or Position: PRESIDENT
Credential: DDS
Phone: 919-870-7645