Basic Information
| Provider Information | |||||||||
| NPI: | 1649670852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGGARWAL | ||||||||
| FirstName: | SAPNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507034407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198743000 | ||||||||
| FaxNumber: | 3198743477 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3198743000 | ||||||||
| FaxNumber: | 3198743447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2014 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DEN4483 | ME | N | Dental Providers | Dentist | 122300000X | DDS-09716 | IA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 0076372 | 05 | IA | MEDICAID |