MEDICARE: BENJAMIN JAMES NAGEL 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	122300000X	Dentist	08262	IA

General Provider Information

NPI Number	:	1710183256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JAMES NAGEL D.D.S.

Provider Business Mailing Address
First Line	:	12600 PRAIRIE DR
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50323-2378
Country	:	US
Telephone Number	:	515-243-9677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 WESTOWN PKWY
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1029
Country	:	US
Telephone Number	:	515-225-6742
Fax Number	:	515-224-1560

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

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	06/16/2014

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