Provider Demographics
NPI:1144822420
Name:ANJU AGNISH, DMD PC
Entity type:Organization
Organization Name:ANJU AGNISH, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:POOJA
Authorized Official - Middle Name:ANJU
Authorized Official - Last Name:AGNISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-644-3900
Mailing Address - Street 1:113 W INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-5315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 W INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5315
Practice Address - Country:US
Practice Address - Phone:570-644-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental