Provider Demographics
NPI:1780706655
Name:ALLA AGAMOV DMD
Entity type:Organization
Organization Name:ALLA AGAMOV DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-784-8435
Mailing Address - Street 1:47 POND STREET
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-784-8435
Mailing Address - Fax:781-784-6598
Practice Address - Street 1:47 POND STREET
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067
Practice Address - Country:US
Practice Address - Phone:781-784-8435
Practice Address - Fax:781-784-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty