=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063686533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGGARWAL DENTAL CENTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2008
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2640 SALEM AVE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45406-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-276-9788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2640 SALEM AVE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45406-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-276-9788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIS
-----------------------------------------------------
Name | DR. TRUSHA PATEL AGGARWAL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 937-276-9788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 20617
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 20887
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------