Provider Demographics
NPI:1588166318
Name:NAGEL, MARGO KATHRYN (DDS)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:KATHRYN
Last Name:NAGEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARGO
Other - Middle Name:NAGEL
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:175 E 7TH AVE APT 617
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1610 CANYON BLVD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5407
Practice Address - Country:US
Practice Address - Phone:303-442-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO00204041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program