Healthcare Provider Details

I. General information

NPI: 1235361791
Provider Name (Legal Business Name): JEFFREY NAGEL D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST STE. 301
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

3695 ALAMO ST STE. 301
SIMI VALLEY CA
93063-2188
US

V. Phone/Fax

Practice location:
  • Phone: 805-581-2480
  • Fax:
Mailing address:
  • Phone: 805-581-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number56842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: