MEDICARE: MR. PAUL DENNIS NAGODE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 008067	GA

General Provider Information

NPI Number	:	1235224304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL DENNIS NAGODE DDS

Provider Business Mailing Address
First Line	:	6075 LAKE FORREST DR
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328-3845
Country	:	US
Telephone Number	:	404-303-1199
Fax Number	:	404-303-1667

Provider Business Practice Location Address
First Line	:	6075 LAKE FORREST DR
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328-3845
Country	:	US
Telephone Number	:	404-303-1199
Fax Number	:	404-303-1667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/31/2012

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