Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02234700 | NJ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401412743 | VA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0101247300 | VA |
NPI | 1205006509 |
---|---|
Provider Name | Dr. Neil Agnihotri |
First Address | Glen Allen, VA 23059-5666 |
Second Address | Richmond, VA 23294-4366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 02/08/2018 |