Healthcare Provider Details

I. General information

NPI: 1730149840
Provider Name (Legal Business Name): NADER NATHAN NAGAVI DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12285 SCRIPPS POWAY PKWY STE 104
POWAY CA
92064-6149
US

IV. Provider business mailing address

2737 SELMA LN
FARMERS BRANCH TX
75234-6342
US

V. Phone/Fax

Practice location:
  • Phone: 858-536-8111
  • Fax:
Mailing address:
  • Phone: 614-288-6827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number22541
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number103569
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11654
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: