MEDICARE: NORMAN J. NAGEL,DDS,MS A DENTAL CORP

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	20916	CA

General Provider Information

NPI Number	:	1346369451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMAN J. NAGEL,DDS,MS A DENTAL CORP

Provider Business Mailing Address
First Line	:	3695 ALAMO ST STE 301
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2188
Country	:	US
Telephone Number	:	805-581-2480
Fax Number	:	805-581-4652

Provider Business Practice Location Address
First Line	:	3695 ALAMO ST STE 301
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2188
Country	:	US
Telephone Number	:	805-581-2480
Fax Number	:	805-581-4652

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NORMAN J. NAGEL
Credential	:	D.D.S., M.S.
Telephone Number	:	805-581-2480

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	05/20/2010

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