Provider Demographics
NPI:1306675186
Name:AGARWAL, DEEPALI GOPAL (DDS)
Entity type:Individual
Prefix:
First Name:DEEPALI
Middle Name:GOPAL
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ELAN VILLAGE LN UNIT 204
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2576
Mailing Address - Country:US
Mailing Address - Phone:206-428-8303
Mailing Address - Fax:
Practice Address - Street 1:171 CURTNER AVE STE 80
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-1059
Practice Address - Country:US
Practice Address - Phone:408-572-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS110148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist