MEDICARE: DR. DOUGLAS JAY NAGLE DMD MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DS030441L	PA

General Provider Information

NPI Number	:	1346331915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS JAY NAGLE DMD MS

Provider Business Mailing Address
First Line	:	1951 SHENANGO VALLEY FREEWAY
Second Line	:	SUITE 4 NORTH
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2522
Country	:	US
Telephone Number	:	724-347-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 SHENANGO VALLEY FREEWAY
Second Line	:	SUITE 4 NORTH
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2522
Country	:	US
Telephone Number	:	724-347-0540
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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