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General NPI Number Information
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NPI Number | 1619394350
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Entity Type | Organization
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Legal Business Name | MONA AGARWAL DENTISTRY PLLC
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 1331 W WILSON ST
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City | BORGER
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State | TX
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Zip | 79007-4421
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Country | US
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Telephone | 682-234-4603
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Fax |
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Provider Business Mailing Address
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Address Line | 8337 SUMMER PARK DR
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City | FORT WORTH
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State | TX
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Zip | 76123-1991
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Country | US
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Telephone | 682-234-4603
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. MONA AGARWAL
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Credential | DDS
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Telephone | 682-234-4603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27214
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License Number State | TX
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