Provider Demographics
NPI:1205006509
Name:AGNIHOTRI, NEIL (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:AGNIHOTRI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11545A NUCKOLS ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5666
Mailing Address - Country:US
Mailing Address - Phone:804-673-8061
Mailing Address - Fax:804-673-5644
Practice Address - Street 1:130 TOWNE CENTER WEST BOULEVARD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7100
Practice Address - Country:US
Practice Address - Phone:804-270-5028
Practice Address - Fax:804-747-3599
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247300204E00000X
VA04014127431223S0112X
NJ22DI02234700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist