Provider Demographics
NPI:1588060578
Name:NAGORI, HIDAYATULLA R (BDS, MPA, CAGS)
Entity type:Individual
Prefix:DR
First Name:HIDAYATULLA
Middle Name:R
Last Name:NAGORI
Suffix:
Gender:M
Credentials:BDS, MPA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31480 CONCORD DR APT F
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1731
Mailing Address - Country:US
Mailing Address - Phone:216-835-1165
Mailing Address - Fax:
Practice Address - Street 1:1400 GUADALUPE ST
Practice Address - Street 2:SUIT # A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5315
Practice Address - Country:US
Practice Address - Phone:956-568-5537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics