Provider Demographics
NPI:1316095631
Name:AGADI, BHAVANA (DMD)
Entity type:Individual
Prefix:
First Name:BHAVANA
Middle Name:
Last Name:AGADI
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 1:147 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545
Mailing Address - Country:US
Mailing Address - Phone:617-694-2371
Mailing Address - Fax:
Practice Address - Street 1:DENTAL SMILES CENTER, 1241 MAIN ST
Practice Address - Street 2:UNIT #8
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603
Practice Address - Country:US
Practice Address - Phone:508-797-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0205168Medicaid