Healthcare Provider Details

I. General information

NPI: 1346331915
Provider Name (Legal Business Name): DOUGLAS JAY NAGLE DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SHENANGO VALLEY FREEWAY SUITE 4 NORTH
HERMITAGE PA
16148-2522
US

IV. Provider business mailing address

1951 SHENANGO VALLEY FREEWAY SUITE 4 NORTH
HERMITAGE PA
16148-2522
US

V. Phone/Fax

Practice location:
  • Phone: 724-347-0540
  • Fax:
Mailing address:
  • Phone: 724-347-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS030441L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: