Provider Demographics
NPI:1174075816
Name:DR. PRATIKSHA AGRAWAL DENTAL SERVICES PC
Entity type:Organization
Organization Name:DR. PRATIKSHA AGRAWAL DENTAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:PRATIKSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-208-5566
Mailing Address - Street 1:1468 DEVON LANE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:312-208-5566
Mailing Address - Fax:
Practice Address - Street 1:2550 TELEGRAPH ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOLFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-292-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty