Provider Demographics
NPI:1760635585
Name:GAURAV AGARWAL DDS, MSD, PLLC
Entity type:Organization
Organization Name:GAURAV AGARWAL DDS, MSD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAURAV
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:540-667-5437
Mailing Address - Street 1:1705 AMHERST STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-5437
Mailing Address - Fax:540-667-6555
Practice Address - Street 1:1705 AMHERST STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-5437
Practice Address - Fax:540-667-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411194261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental