MEDICARE: AGOKA DENTAL PLLC

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	DN13286	FL

General Provider Information

NPI Number	:	1639685621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGOKA DENTAL PLLC

Provider Business Mailing Address
First Line	:	3306 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2904
Country	:	US
Telephone Number	:	813-879-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3306 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2904
Country	:	US
Telephone Number	:	813-879-9000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NARESH A KALRA
Credential	:	BDS, DDS
Telephone Number	:	813-879-9000

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	12/28/2017

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