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General NPI Number Information
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NPI Number | 1851929434
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Entity Type | Organization
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Legal Business Name | ITI AGARWAL, DDS, P.A.
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 5810 HIGHWAY 90
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City | MILTON
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State | FL
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Zip | 32583-1762
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Country | US
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Telephone | 301-806-7719
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 MAGNOLIA AVE
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City | PENSACOLA
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State | FL
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Zip | 32503-4875
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ITI AGARWAL
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Credential |
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Telephone | 301-806-7719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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