Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 20025 | TX |
NPI | 1043249287 |
---|---|
Provider Name | Nagi M Demian |
First Address | Dallas, TX 75303-1173 |
Second Address | Houston, TX 77030-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 01/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175800501 | (05) | TX |
89D304 | BCBS (01) | TX |
V06405 | (02) | TX |