Provider Demographics
NPI:1396092557
Name:NADER NATHAN NAGAVI, D.D.S, P.A.
Entity type:Organization
Organization Name:NADER NATHAN NAGAVI, D.D.S, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NADER
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:NAGAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-241-1934
Mailing Address - Street 1:8 MEDICAL PKWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7859
Mailing Address - Country:US
Mailing Address - Phone:972-241-1934
Mailing Address - Fax:972-481-1906
Practice Address - Street 1:8 MEDICAL PKWY
Practice Address - Street 2:SUITE 308
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7859
Practice Address - Country:US
Practice Address - Phone:972-241-1934
Practice Address - Fax:972-481-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty