Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 27866 | TX |
NPI | 1114127677 |
---|---|
Provider Name | Justin Wayne Nagel |
First Address | Carrollton, TX 75010-4649 |
Second Address | Carrollton, TX 75010-4649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 28/01/2014 |