Provider Demographics
NPI:1447326871
Name:AGGARWAL, AMITA (DMD)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:
Last Name:AGGARWAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1512
Mailing Address - Country:US
Mailing Address - Phone:860-342-3303
Mailing Address - Fax:860-342-1929
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1512
Practice Address - Country:US
Practice Address - Phone:860-342-3303
Practice Address - Fax:860-342-1929
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0089111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice