Shobhit Agarwal, DMD
Individual provider Active NPI Dentist · Brockton, MA
NPI 1346725843 · NPPES record last updated Oct 1, 2018
Key facts
- NPI
- 1346725843
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN1858119 (MA)
- Practice address
- 165 Westgate Dr
Brockton, MA 02301-1821 - Phone
- (508) 841-5353
- NPI assigned
- Oct 1, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220613001993 | CT | Order and Referring Only - Dentist |
1759769243 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1858119 | MA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1858119 | MA | Yes |
Addresses
Primary practice location
165 Westgate Dr
Brockton, MA 02301-1821
Mailing address
95 W Squantum St Apt 1104
North Quincy, MA 02171-2111
Phone (186) 221-5165
Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.