MEDICARE: PROF. BRETT M NAGATANI D.D.S.

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	1223E0200X	Endodontics	55266	CA
2	1223E0200X	Endodontics	22375	TX
3	1223E0200X	Endodontics	DT - 2276	HI

General Provider Information

NPI Number	:	1649241092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. BRETT M NAGATANI D.D.S.

Provider Business Mailing Address
First Line	:	11551 AMALFI WAY
Second Line	:
City	:	PORTER RANCH
State	:	CA
Zip	:	91326-4099
Country	:	US
Telephone Number	:	323-440-3584
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 W 34TH ST STE 124C
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0641
Country	:	US
Telephone Number	:	213-740-1080
Fax Number	:

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	09/12/2014

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