Healthcare Provider Details

I. General information

NPI: 1881847044
Provider Name (Legal Business Name): BRIAN TERUMI NAGAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE 430
LA MESA CA
91942-3068
US

IV. Provider business mailing address

10531 4S COMMONS DR SUITE 175
SAN DIEGO CA
92127-3517
US

V. Phone/Fax

Practice location:
  • Phone: 619-713-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number55878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: