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General NPI Number Information
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NPI Number | 1790901213
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Entity Type | Organization
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Legal Business Name | DR. DEEP AGEE PA
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 STATE RD 436 SUITE 100
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City | CASSELBERRY
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State | FL
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Zip | 32707
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Country | US
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Telephone | 407-339-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 400 STATE RD 436 SUITE 100
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City | CASSELBERRY
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State | FL
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Zip | 32707
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Country | US
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Telephone | 407-339-2442
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Fax |
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Authorized Official
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Title or Position | DENTIST, PRESIDENT
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Name | DR. DEEP AGEE
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Credential | GENERAL DENTIST
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Telephone | 407-339-2442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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