MEDICARE: DR. AMI AGBABLI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4004	AR

General Provider Information

NPI Number	:	1093136327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMI AGBABLI DDS

Provider Business Mailing Address
First Line	:	1301 E ROBINSON AVE STE B5
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 E ROBINSON AVE STE B5
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5614
Country	:	US
Telephone Number	:	479-927-6420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	05/21/2026

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