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General NPI Number Information
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NPI Number | 1750524351
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Entity Type | Individual
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Provider Name | NEERAJ RAVINDRA NAGELLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2009
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 17910 BULVERDE RD STE 112
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City | SAN ANTONIO
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State | TX
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Zip | 78259-3762
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Country | US
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Telephone | 210-494-4200
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Fax | 210-491-5959
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Provider Business Mailing Address
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Address Line | 7167 BELLA GDN
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City | SAN ANTONIO
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State | TX
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Zip | 78256-2123
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Country | US
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Telephone | 210-557-4005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN17181
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 31728
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License Number State | TX
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