MEDICARE: PAUL D NAGODE DDS PC

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	8067	GA

General Provider Information

NPI Number	:	1912085366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL D NAGODE DDS PC

Provider Business Mailing Address
First Line	:	6075 LAKE FORREST DRIVE
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328-3845
Country	:	US
Telephone Number	:	404-303-1199
Fax Number	:	404-303-1667

Provider Business Practice Location Address
First Line	:	6075 LAKE FORREST DRIVE
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30328-3845
Country	:	US
Telephone Number	:	404-303-1199
Fax Number	:	404-303-1667

Authorized Official
Title or Position	:	OWNER
Name	:	PAUL D NAGODE
Credential	:	DDS
Telephone Number	:	404-303-1199

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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