Provider Demographics
NPI:1063709830
Name:AGNERO, FANNY KAMWA (DMD,MPH)
Entity type:Individual
Prefix:DR
First Name:FANNY
Middle Name:KAMWA
Last Name:AGNERO
Suffix:
Gender:F
Credentials:DMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 E US HIGHWAY 83 STE 3
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9433
Mailing Address - Country:US
Mailing Address - Phone:956-317-1365
Mailing Address - Fax:
Practice Address - Street 1:5342 E US HIGHWAY 83 STE 3
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9433
Practice Address - Country:US
Practice Address - Phone:956-317-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02487800122300000X
TX278611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty