Provider Demographics
NPI:1831267012
Name:DENNIS W NAGEL DDS PC
Entity type:Organization
Organization Name:DENNIS W NAGEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-942-8461
Mailing Address - Street 1:2100 RAYBROOK DR SE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-942-8461
Mailing Address - Fax:616-942-2311
Practice Address - Street 1:2100 RAYBROOK DR SE
Practice Address - Street 2:SUITE 105
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-942-8461
Practice Address - Fax:616-942-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010107141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty