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General NPI Number Information
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NPI Number | 1053824987
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Entity Type | Individual
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Provider Name | MANIKA AGARWAL DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 275 N YORK ST STE 200
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City | ELMHURST
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State | IL
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Zip | 60126-2780
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Country | US
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Telephone | 630-832-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 520 N KINGSBURY ST UNIT 4603
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City | CHICAGO
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State | IL
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Zip | 60654-8616
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Country | US
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Telephone | 201-602-9150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021002810
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License Number State | IL
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