MEDICARE: ELNAGGAR DDS INC

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	122300000X	Dentist	60170	CA

General Provider Information

NPI Number	:	1427447028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELNAGGAR DDS INC

Provider Business Mailing Address
First Line	:	20913 SHERMAN WAY
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1743
Country	:	US
Telephone Number	:	818-992-4600
Fax Number	:	818-992-4602

Provider Business Practice Location Address
First Line	:	20913 SHERMAN WAY
Second Line	:
City	:	CANOGA PARK
State	:	CA
Zip	:	91303-1743
Country	:	US
Telephone Number	:	818-992-4600
Fax Number	:	818-992-4602

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MAGED M ELNAGGAR
Credential	:	DDS
Telephone Number	:	818-667-8257

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	08/05/2020

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