Provider Demographics
NPI:1982396917
Name:AGATE DENTAL PLLC
Entity type:Organization
Organization Name:AGATE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKPOVONA
Authorized Official - Middle Name:
Authorized Official - Last Name:EFETURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-816-0968
Mailing Address - Street 1:1700 BENT CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1870
Mailing Address - Country:US
Mailing Address - Phone:617-963-1959
Mailing Address - Fax:
Practice Address - Street 1:1700 BENT CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1870
Practice Address - Country:US
Practice Address - Phone:617-963-4959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty