Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901022372 | MI |
NPI | 1003338468 |
---|---|
Provider Name | Dr. Anshita Agarwal |
First Address | Rochester Hills, MI 48307-3910 |
Second Address | Rochester Hills, MI 48307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2017 |
Last Update Date | 07/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A264067019797 | DRIVERS LICENSE (01) | MI |